Healthcare Provider Details

I. General information

NPI: 1356557789
Provider Name (Legal Business Name): JOHN ROBERT LUNDSTROM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HIGHWAY 61 N SUITE 100
WHITE BEAR LAKE MN
55110-2737
US

IV. Provider business mailing address

4801 HIGHWAY 61 N SUITE 100
WHITE BEAR LAKE MN
55110-2737
US

V. Phone/Fax

Practice location:
  • Phone: 651-429-5401
  • Fax: 651-429-8930
Mailing address:
  • Phone: 651-429-5401
  • Fax: 651-429-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2261
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2261
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: