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General NPI Number Information
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NPI Number | 1073879466
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Entity Type | Organization
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Legal Business Name | LUNDSTROM CHIROPRACTIC CENTERS, INC.
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 111 CENTRAL AVE N SUITE 2
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City | FARIBAULT
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State | MN
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Zip | 55021-5252
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Country | US
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Telephone | 507-384-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CENTRAL AVE N SUITE 2
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City | FARIBAULT
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State | MN
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Zip | 55021-5252
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Country | US
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Telephone | 507-384-3588
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ROBERT LUNDSTROM
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Credential | D.C.
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Telephone | 651-235-1403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5646
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License Number State | MN
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