Provider Demographics
NPI:1275627903
Name:LINDBERG, BRUCE ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
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 1:200 W 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3820
Mailing Address - Country:US
Mailing Address - Phone:952-881-4421
Mailing Address - Fax:
Practice Address - Street 1:200 W 98TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3820
Practice Address - Country:US
Practice Address - Phone:952-881-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN09866LIOtherCC SYSTEMS
MN230494OtherCHIROCARE OF MN (ACN)
MN94265OtherMEDICA
MN09866LIOtherBCBSM
MN134327100Medicaid
MN09866LIOtherCC SYSTEMS