Provider Demographics
NPI:1871505602
Name:LUND, JOHN L (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:LUND
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 1:710 BROOKSIDE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5181
Mailing Address - Country:US
Mailing Address - Phone:909-335-1313
Mailing Address - Fax:909-335-1313
Practice Address - Street 1:710 BROOKSIDE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5181
Practice Address - Country:US
Practice Address - Phone:909-335-1313
Practice Address - Fax:909-335-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC011008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04159Medicare UPIN
CADC0110080Medicare ID - Type Unspecified