Healthcare Provider Details

I. General information

NPI: 1679717870
Provider Name (Legal Business Name): MATTHEW J. LUNDEBERG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7687 BEECHMONT AVE
CINCINNATI OH
45255-4216
US

IV. Provider business mailing address

7687 BEECHMONT AVE
CINCINNATI OH
45255-4216
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-9040
  • Fax: 513-232-9376
Mailing address:
  • Phone: 513-232-9040
  • Fax: 513-232-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1781
License Number StateOH

VIII. Authorized Official

Name: MATTHEW LUNDEBERG
Title or Position: PRESIDENT
Credential: DC
Phone: 513-271-1233