Healthcare Provider Details

I. General information

NPI: 1003987876
Provider Name (Legal Business Name): ERICK JAMES LUNDGREN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LAKE ROAD AVE STE 301
ROBBINSDALE MN
55422
US

IV. Provider business mailing address

4600 LAKE ROAD AVE STE 301
ROBBINSDALE MN
55422-1845
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-7099
  • Fax: 763-522-2222
Mailing address:
  • Phone: 763-588-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4639
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: