Provider Demographics
NPI:1700941069
Name:ADVANCED CHIROPRACTIC & WELLNESS, P.A.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC & WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-779-5998
Mailing Address - Street 1:1752 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6516
Mailing Address - Country:US
Mailing Address - Phone:651-779-5998
Mailing Address - Fax:651-779-7165
Practice Address - Street 1:1752 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6516
Practice Address - Country:US
Practice Address - Phone:651-779-5998
Practice Address - Fax:651-779-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN594K7ADOtherBLUECROSS BLUESHIELD