Provider Demographics
NPI:1548386618
Name:LINGREN, LOUIS GLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:GLEN
Last Name:LINGREN
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 1:3750 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2607
Mailing Address - Country:US
Mailing Address - Phone:951-684-2350
Mailing Address - Fax:951-684-9340
Practice Address - Street 1:3750 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2607
Practice Address - Country:US
Practice Address - Phone:951-684-2350
Practice Address - Fax:951-684-9340
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0107330Medicare ID - Type Unspecified