Provider Demographics
NPI:1457798761
Name:LUNDIN, DANA (LAC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LUNDIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 VINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1523
Mailing Address - Country:US
Mailing Address - Phone:312-638-0818
Mailing Address - Fax:312-588-3301
Practice Address - Street 1:150 N MICHIGAN AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7553
Practice Address - Country:US
Practice Address - Phone:312-638-0818
Practice Address - Fax:312-588-3301
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000403171100000X
MIL2143588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist