MEDICARE: DR. ALAN RUSS LUNDEEN D.C.

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	7575	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1134201668	OTHER	AZ	GROUP NPI

General Provider Information

NPI Number	:	1518143981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN RUSS LUNDEEN D.C.

Provider Business Mailing Address
First Line	:	201 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2327
Country	:	US
Telephone Number	:	602-503-1424
Fax Number	:	602-532-9516

Provider Business Practice Location Address
First Line	:	201 E OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2327
Country	:	US
Telephone Number	:	602-503-1424
Fax Number	:	602-532-9516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	04/01/2009

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