Provider Demographics
NPI:1255522686
Name:LUNGREN, DAVID EDWARD (DC CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:LUNGREN
Suffix:
Gender:M
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 TRAVOIS CIR
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-9395
Mailing Address - Country:US
Mailing Address - Phone:530-677-4601
Mailing Address - Fax:
Practice Address - Street 1:3440 PALMER DR
Practice Address - Street 2:8G
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8234
Practice Address - Country:US
Practice Address - Phone:530-677-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor