Provider Demographics
NPI:1023499928
Name:LINDSTROM CHIROPRACTIC CENTER, PA
Entity type:Organization
Organization Name:LINDSTROM CHIROPRACTIC CENTER, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:651-257-1103
Mailing Address - Street 1:10995 CLUB WEST PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5058
Mailing Address - Country:US
Mailing Address - Phone:763-400-4940
Mailing Address - Fax:763-634-8580
Practice Address - Street 1:10995 CLUB WEST PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5058
Practice Address - Country:US
Practice Address - Phone:763-400-4940
Practice Address - Fax:763-634-8580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDSTROM CHIROPRACTIC CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty