Provider Demographics
NPI:1861654469
Name:LUNDGREN CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:LUNDGREN CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-793-4858
Mailing Address - Street 1:2965 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2814
Mailing Address - Country:US
Mailing Address - Phone:309-793-4858
Mailing Address - Fax:
Practice Address - Street 1:2965 13TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-2814
Practice Address - Country:US
Practice Address - Phone:309-793-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8122098OtherBLUE CROSS BLUE SHIELD
IL443330OtherMEDICARE
ILU71745Medicare UPIN