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Individual

DR. JENNIFER MARIE LIDSTROM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S.,D.C.,P.C.

Contact information

Practice address
19924 JETTON RD, SUITE 101, CORNELIUS, NC 28031-8250
(704) 876-8446
(704) 896-8495
Mailing address
19924 JETTON RD, SUITE 101, CORNELIUS, NC 28031-8250
(704) 876-8446
(704) 896-8495

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3249
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
89085RN
NC
Enumeration date
09/14/2006
Last updated
05/15/2020
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