| Lundgren Chiropractic Center Llc | |
|
2003 Southern Blvd Se Ste 109 Rio Rancho NM 87124-3752 | |
| (505) 917-3677 | |
| Not Available |
| Full Name | Lundgren Chiropractic Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2003 Southern Blvd Se Ste 109, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Austin Lundgren (OWNER) |
| Authorized Official Contact | 5059173677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lundgren Chiropractic Center Llc 5821 Plaza Paseo St Nw Albuquerque NM 87114-4808 Ph: (505) 917-3677 | Lundgren Chiropractic Center Llc 2003 Southern Blvd Se Ste 109 Rio Rancho NM 87124-3752 Ph: (505) 917-3677 |
| NPI Number | 1275155475 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 08/04/2020 |
| Medicare PECOS PAC ID | 0446660039 |
|---|---|
| Medicare Enrollment ID | O20201111000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275155475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Holly Michelle Tharp |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1407450521 PECOS PAC ID: 0244641942 Enrollment ID: I20201202000679 |
| Provider Name | Austin Greg Lundgren |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1508460627 PECOS PAC ID: 6800206491 Enrollment ID: I20201230002083 |
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