MEDICARE: DR. JORDAN DERRICK LUNSKI DC

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	1118	ND

General Provider Information

NPI Number	:	1821629221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN DERRICK LUNSKI DC

Provider Business Mailing Address
First Line	:	5960 E PRAIRIEWOOD DR
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3241
Country	:	US
Telephone Number	:	701-739-2423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 S WASHINGTON ST STE B
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-8155
Country	:	US
Telephone Number	:	701-739-2423
Fax Number	:

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

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	02/04/2020

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