MEDICARE: DR. LESLIE ERIN LUND 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	038006999	IL

General Provider Information

NPI Number	:	1851386304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ERIN LUND DC

Provider Business Mailing Address
First Line	:	325 N MAIN ST
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-1728
Country	:	US
Telephone Number	:	815-872-0476
Fax Number	:	815-872-0476

Provider Business Practice Location Address
First Line	:	325 N MAIN ST
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-1728
Country	:	US
Telephone Number	:	815-872-0476
Fax Number	:	815-872-0476

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/19/2010

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