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General NPI Number Information
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NPI Number | 1487972758
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Entity Type | Organization
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Legal Business Name | LUNDELL CHIROPRACTIC HEALTH CENTER
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 1222 GRANITE ST
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City | GRANITE FALLS
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State | MN
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Zip | 56241-1359
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Country | US
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Telephone | 320-564-1209
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Fax | 320-564-1210
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Provider Business Mailing Address
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Address Line | 1222 GRANITE ST
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City | GRANITE FALLS
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State | MN
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Zip | 56241-1359
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Country | US
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Telephone | 320-564-1209
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Fax | 320-564-1210
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Authorized Official
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Title or Position | OWNER
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Name | KATY LYNN LUNDELL
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Credential | DC
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Telephone | 320-564-1209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5371
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License Number State | MN
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