Provider Demographics
NPI:1053349464
Name:LUND, THADEUS MARSHALL (DC)
Entity type:Individual
Prefix:
First Name:THADEUS
Middle Name:MARSHALL
Last Name:LUND
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 1:851 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3401
Mailing Address - Country:US
Mailing Address - Phone:760-745-7251
Mailing Address - Fax:760-745-7248
Practice Address - Street 1:851 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3401
Practice Address - Country:US
Practice Address - Phone:760-745-7251
Practice Address - Fax:760-745-7248
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor