Healthcare Provider Details

I. General information

NPI: 1508460627
Provider Name (Legal Business Name): AUSTIN GREG LUNDGREN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 SOUTHERN BLVD SE STE 304
RIO RANCHO NM
87124-2087
US

IV. Provider business mailing address

5821 PLAZA PASEO ST NW
ALBUQUERQUE NM
87114-4808
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-2222
  • Fax: 505-892-1056
Mailing address:
  • Phone: 505-917-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC2255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: