MEDICARE: MATTHEW J. LUNDEBERG, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3069	OH

General Provider Information

NPI Number	:	1134308182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW J. LUNDEBERG, INC.

Provider Business Mailing Address
First Line	:	5721 DRAGON WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-4518
Country	:	US
Telephone Number	:	513-271-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	5721 DRAGON WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-4518
Country	:	US
Telephone Number	:	513-271-1233
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW J LUNDEBERG
Credential	:	DC
Telephone Number	:	513-271-1233

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	05/21/2021

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