MEDICARE: DR. LISA MARIE LUNDSTROM 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	905	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962409771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE LUNDSTROM D.C.

Provider Business Mailing Address
First Line	:	2709 LAZELLE ST STE B
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2999
Country	:	US
Telephone Number	:	605-720-6288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 LAZELLE ST STE B
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2999
Country	:	US
Telephone Number	:	605-720-6288
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/06/2019

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