Provider Demographics
NPI:1043548951
Name:LINDSTROM CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:LINDSTROM CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:651-257-1103
Mailing Address - Street 1:12099 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9322
Mailing Address - Country:US
Mailing Address - Phone:651-257-1103
Mailing Address - Fax:
Practice Address - Street 1:12099 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9322
Practice Address - Country:US
Practice Address - Phone:651-257-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1473111N00000X
MN5301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0035908OtherRAILROAD MEDICARE
MN219825800OtherMEDICAL ASSISTANCE
MN219825800OtherMEDICAL ASSISTANCE