Provider Demographics
NPI:1851386304
Name:LUND, LESLIE ERIN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ERIN
Last Name:LUND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1728
Mailing Address - Country:US
Mailing Address - Phone:815-872-0476
Mailing Address - Fax:815-872-0476
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1728
Practice Address - Country:US
Practice Address - Phone:815-872-0476
Practice Address - Fax:815-872-0476
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
204600Medicare ID - Type Unspecified
U87663Medicare UPIN