MEDICARE: DAVID NICHOLAS LUNDQUIST D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH4169	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350006289	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1891710075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID NICHOLAS LUNDQUIST D.C.

Provider Business Mailing Address
First Line	:	601 AVENUE B NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4656
Country	:	US
Telephone Number	:	863-293-8686
Fax Number	:	863-299-1764

Provider Business Practice Location Address
First Line	:	601 AVENUE B NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4656
Country	:	US
Telephone Number	:	863-293-8686
Fax Number	:	863-299-1764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/13/2008

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Directions to “ DAVID NICHOLAS LUNDQUIST D.C.” Practice Location

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