Provider Demographics
NPI:1891710075
Name:LUNDQUIST, DAVID NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NICHOLAS
Last Name:LUNDQUIST
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 1:601 AVENUE B NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4656
Mailing Address - Country:US
Mailing Address - Phone:863-293-8686
Mailing Address - Fax:863-299-1764
Practice Address - Street 1:601 AVENUE B NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4656
Practice Address - Country:US
Practice Address - Phone:863-293-8686
Practice Address - Fax:863-299-1764
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350006289OtherRAILROAD MEDICARE
FL88010ZMedicare ID - Type Unspecified
FLT85805Medicare UPIN