Provider Demographics
NPI:1770348492
Name:LUND, ISAAC JAMES (DC)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:JAMES
Last Name:LUND
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 1:3919 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5642
Mailing Address - Country:US
Mailing Address - Phone:218-236-8695
Mailing Address - Fax:
Practice Address - Street 1:1383 21ST AVE N STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1841
Practice Address - Country:US
Practice Address - Phone:701-365-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor