Provider Demographics
NPI:1255542130
Name:LUND FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:LUND FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-326-8422
Mailing Address - Street 1:112 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1642
Mailing Address - Country:US
Mailing Address - Phone:608-326-8422
Mailing Address - Fax:608-326-7140
Practice Address - Street 1:112 S OHIO ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1642
Practice Address - Country:US
Practice Address - Phone:608-326-8422
Practice Address - Fax:608-326-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3186-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035355Medicare PIN
WIU54336Medicare UPIN
WI000035355Medicare ID - Type Unspecified