Provider Demographics
NPI:1275155475
Name:LUNDGREN CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:LUNDGREN CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-917-3677
Mailing Address - Street 1:3301 SOUTHERN BLVD SE STE 304
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2087
Mailing Address - Country:US
Mailing Address - Phone:505-892-2222
Mailing Address - Fax:505-892-1056
Practice Address - Street 1:3301 SOUTHERN BLVD SE STE 304
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2087
Practice Address - Country:US
Practice Address - Phone:505-892-2222
Practice Address - Fax:505-892-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center