Provider Demographics
NPI:1154586634
Name:LONSDALE CHIROPRACTIC
Entity type:Organization
Organization Name:LONSDALE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LIESKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-744-5514
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55046-0162
Mailing Address - Country:US
Mailing Address - Phone:507-744-5514
Mailing Address - Fax:507-744-5513
Practice Address - Street 1:100 MAIN ST SO
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:MN
Practice Address - Zip Code:55046-0162
Practice Address - Country:US
Practice Address - Phone:507-744-5514
Practice Address - Fax:507-744-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C797LOOtherBC/BS