Provider Demographics
NPI:1114004520
Name:LINDSTROM-WOLD, MAE BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MAE BETH
Middle Name:
Last Name:LINDSTROM-WOLD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-2011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2002 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-2011
Practice Address - Country:US
Practice Address - Phone:507-836-8911
Practice Address - Fax:507-836-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2724OtherSTATE DC LICENSE
MN64818LIOtherBLUE CROSS PROVIDER ID
MNU19834Medicare UPIN