Provider Demographics
NPI:1992261697
Name:LISA LUNDSTROM CHIROPRACTIC PC
Entity type:Organization
Organization Name:LISA LUNDSTROM CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-391-8188
Mailing Address - Street 1:2709 LAZELLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2999
Mailing Address - Country:US
Mailing Address - Phone:605-720-6288
Mailing Address - Fax:
Practice Address - Street 1:2709 LAZELLE ST STE B
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2999
Practice Address - Country:US
Practice Address - Phone:605-720-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty