Provider Demographics
NPI:1245304955
Name:LUNDBERG, KURT R (DC)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:R
Last Name:LUNDBERG
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:PO BOX 7340
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-7340
Mailing Address - Country:US
Mailing Address - Phone:908-510-3190
Mailing Address - Fax:732-246-4721
Practice Address - Street 1:330 LIVINGSTON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3469
Practice Address - Country:US
Practice Address - Phone:732-246-4226
Practice Address - Fax:732-246-4721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00391600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor