Provider Demographics
NPI:1770777203
Name:LUNDGREN CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:LUNDGREN CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-732-0442
Mailing Address - Street 1:805 E. WARNER RD.
Mailing Address - Street 2:#102
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225
Mailing Address - Country:US
Mailing Address - Phone:480-732-0442
Mailing Address - Fax:480-732-9868
Practice Address - Street 1:805 E. WARNER RD.
Practice Address - Street 2:#102
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225
Practice Address - Country:US
Practice Address - Phone:480-732-0442
Practice Address - Fax:480-732-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106516Medicare PIN
AZU56634Medicare UPIN