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Organization

LINDSTROM CHIROPRACTIC CENTER, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT DONALD WADDELL II D.C. (PRESIDENT)
(651) 257-1103
Entity
Organization

Contact information

Practice address
12099 LAKE BLVD, LINDSTROM, MN 55045-9322
(651) 257-1103
Mailing address
12099 LAKE BLVD, LINDSTROM, MN 55045-9322
(651) 257-1103

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1473
MN
111N00000X
Chiropractor
Primary
5301
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0035908
RAILROAD MEDICARE
MN
01
219825800
MEDICAL ASSISTANCE
MN
Enumeration date
12/04/2009
Last updated
12/04/2009
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