Provider Demographics
NPI:1467509083
Name:COLE, LORI A (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:COLE
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 1:209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3075
Mailing Address - Country:US
Mailing Address - Phone:507-444-0868
Mailing Address - Fax:507-444-0867
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3075
Practice Address - Country:US
Practice Address - Phone:507-444-0868
Practice Address - Fax:507-444-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5B408COOtherBLUE CROSS
MNU36769Medicare UPIN
MN5B409COMedicare ID - Type Unspecified