Healthcare Provider Details

I. General information

NPI: 1275594350
Provider Name (Legal Business Name): MATTHEW J LUNDEBERG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 RIVERSIDE DR
DUBLIN OH
43017-9503
US

IV. Provider business mailing address

5721 DRAGON WAY
CINCINNATI OH
45227-4518
US

V. Phone/Fax

Practice location:
  • Phone: 614-660-5560
  • Fax: 614-633-1134
Mailing address:
  • Phone: 513-271-1233
  • Fax: 513-271-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3069
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: