Healthcare Provider Details

I. General information

NPI: 1760598478
Provider Name (Legal Business Name): KIMBALL T. LUNDAHL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S BALTIC PL
MERIDIAN ID
83642-5935
US

IV. Provider business mailing address

14 S BALTIC PL
MERIDIAN ID
83642-5935
US

V. Phone/Fax

Practice location:
  • Phone: 208-887-4872
  • Fax: 208-887-6331
Mailing address:
  • Phone: 208-887-4872
  • Fax: 208-887-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2671299
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1089
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: