Provider Demographics
NPI:1710085576
Name:MAGELSSEN, LOWELL PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:PETER
Last Name:MAGELSSEN
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 1:1042 HIGHWAY 96 W
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1913
Mailing Address - Country:US
Mailing Address - Phone:651-482-1040
Mailing Address - Fax:651-482-8398
Practice Address - Street 1:1042 HIGHWAY 96 W
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1913
Practice Address - Country:US
Practice Address - Phone:651-482-1040
Practice Address - Fax:651-482-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2067111N00000X
AZ3932111N00000X
WI1916-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN546727600Medicaid
MN350000175Medicare ID - Type Unspecified
MN546727600Medicaid