Provider Demographics
NPI:1164621405
Name:LINDBERG, CORY ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:ROSS
Last Name:LINDBERG
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 1:297 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-4227
Mailing Address - Country:US
Mailing Address - Phone:641-682-8301
Mailing Address - Fax:641-682-8301
Practice Address - Street 1:297 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4227
Practice Address - Country:US
Practice Address - Phone:641-682-8301
Practice Address - Fax:641-682-8301
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor