Provider Demographics
NPI:1790908606
Name:LUNENFELD, MAR C JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:MAR C
Middle Name:JASON
Last Name:LUNENFELD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 LANDS END WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6511
Mailing Address - Country:US
Mailing Address - Phone:757-437-4408
Mailing Address - Fax:
Practice Address - Street 1:6202 N MILITARY HWY
Practice Address - Street 2:SUITE D
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-5447
Practice Address - Country:US
Practice Address - Phone:757-855-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU82275Medicare ID - Type Unspecified