Provider Demographics
NPI:1427130236
Name:LUNDGREN, ANDREW DENNIS (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DENNIS
Last Name:LUNDGREN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 JEWEL AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-2288
Mailing Address - Country:US
Mailing Address - Phone:218-213-6737
Mailing Address - Fax:
Practice Address - Street 1:1015 HELMO AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6032
Practice Address - Country:US
Practice Address - Phone:651-739-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor