Provider Demographics
NPI:1992036180
Name:LUNDELL, KEVIN N (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:N
Last Name:LUNDELL
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 1:5348 S 1900 W
Mailing Address - Street 2:STE #A2
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3019
Mailing Address - Country:US
Mailing Address - Phone:801-810-2005
Mailing Address - Fax:801-623-6777
Practice Address - Street 1:5348 S 1900 W
Practice Address - Street 2:STE #A2
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3019
Practice Address - Country:US
Practice Address - Phone:801-810-2005
Practice Address - Fax:801-623-6777
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7551637-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor