Provider Demographics
NPI:1639133598
Name:LINDBERG, BRENT LANE (DC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:LANE
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
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
Practice Address - Country:US
Practice Address - Phone:641-682-8301
Practice Address - Fax:641-682-8301
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0139899Medicaid
IA0139899Medicaid