Organization
LUNDGREN CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL LUNDGREN D.C. (PRESIDENT)
(406) 586-1984
Entity
Organization
Contact information
Practice address
662 S FERGUSON AVE STE 1, BOZEMAN, MT 59718-6492
(406) 586-1984
(406) 551-2049
Mailing address
662 S FERGUSON AVE STE 1, BOZEMAN, MT 59718-6492
(406) 586-1984
(406) 551-2049
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
708
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M011000442
MEDICARE PTAN
—
Enumeration date
08/13/2010
Last updated
02/23/2021
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