Provider Demographics
NPI:1679751598
Name:MADEJ, LYNNE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:MADEJ
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 1:7700 W OLD SHAKOPEE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-3311
Mailing Address - Country:US
Mailing Address - Phone:952-829-0262
Mailing Address - Fax:952-829-0327
Practice Address - Street 1:7700 W OLD SHAKOPEE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-3311
Practice Address - Country:US
Practice Address - Phone:952-829-0262
Practice Address - Fax:952-829-0327
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC5087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor