Provider Demographics
NPI:1457393704
Name:LINGEN, NICOLE A (DC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:LINGEN
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:
Practice Address - Street 1:3001 SANFORD PKWY
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2700
Practice Address - Country:US
Practice Address - Phone:218-683-2725
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN586171100000X
MNDC4073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP37803OtherHEALTHPARTNERS #
MN21311OtherNDBS #
MN395443900Medicaid
MNDA9020784OtherPREFERRED ONE #
MN1577854OtherAMERICA'S PPO/ARAZ #
MN620054OtherMEDICA #
MN50G09LIOtherMNBS #
MN620054OtherMEDICA #
FM350002466Medicare ID - Type UnspecifiedMN MEDICARE #
MN395443900Medicaid
MNDA9020784OtherPREFERRED ONE #