Organization
JENNIFER LIDSTROM MS DC PC
Active
Other names
Lakeside Sports Chiropractic Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER MARIE LIDSTROM DC (OWNER)
(704) 896-8446
Entity
Organization
Contact information
Practice address
11220 TREYNORTH DR STE A, CORNELIUS, NC 28031-8198
(704) 896-8446
(704) 896-8495
Mailing address
11220 TREYNORTH DR STE A, CORNELIUS, NC 28031-8198
(704) 896-8446
(704) 896-8495
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3249
NC
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89085RM
—
NC
Enumeration date
07/31/2006
Last updated
01/27/2026
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