Provider Demographics
NPI:1871681460
Name:LUNDGREN, DAVID CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:LUNDGREN
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 1:50 NASHUA ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3416
Mailing Address - Country:US
Mailing Address - Phone:603-432-1800
Mailing Address - Fax:603-432-4142
Practice Address - Street 1:50 NASHUA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3400
Practice Address - Country:US
Practice Address - Phone:603-432-1800
Practice Address - Fax:603-432-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH417A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH8664Medicare ID - Type Unspecified
NHT25815Medicare UPIN