Provider Demographics
NPI:1992756944
Name:LUNDY, GLENN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:JAMES
Last Name:LUNDY
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 1:116 N NORWOOD ST STE 6
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-2730
Mailing Address - Country:US
Mailing Address - Phone:910-285-7222
Mailing Address - Fax:910-285-7229
Practice Address - Street 1:116 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-2730
Practice Address - Country:US
Practice Address - Phone:910-285-7222
Practice Address - Fax:910-285-7229
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2913111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU88433Medicare UPIN
NC2454476CMedicare ID - Type UnspecifiedIND. PROVIDER #