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General NPI Number Information
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NPI Number | 1275155475
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Entity Type | Organization
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Legal Business Name | LUNDGREN CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 3301 SOUTHERN BLVD SE STE 304
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City | RIO RANCHO
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State | NM
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Zip | 87124-2087
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Country | US
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Telephone | 505-892-2222
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Fax | 505-892-1056
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Provider Business Mailing Address
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Address Line | 3301 SOUTHERN BLVD SE STE 304
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City | RIO RANCHO
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State | NM
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Zip | 87124-2087
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Country | US
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Telephone | 505-892-2222
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Fax | 505-892-1056
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Authorized Official
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Title or Position | OWNER
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Name | AUSTIN LUNDGREN
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Credential |
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Telephone | 505-917-3677
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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