Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4639 | MN |
NPI | 1003987876 |
---|---|
Provider Name | Dr. Erick James Lundgren |
First Address | Robbinsdale, MN 55422-1845 |
Second Address | Robbinsdale, MN 55422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 05/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C07J2LI | BLUE CROSS BLUE SJIELD (01) | MN |