Provider Demographics
NPI:1740350032
Name:LUNDE, SHAWN SCOTT (DC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:SCOTT
Last Name:LUNDE
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 1:132 MAIN ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612
Mailing Address - Country:US
Mailing Address - Phone:740-703-6368
Mailing Address - Fax:
Practice Address - Street 1:132 MAIN ST.
Practice Address - Street 2:SUITE B
Practice Address - City:BAINBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:45612
Practice Address - Country:US
Practice Address - Phone:740-703-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000341145OtherANTHEM
OH2042015Medicaid
OH0836063Medicare PIN
OH2042015Medicaid