Organization
LIGHTHOUSE CHIROPRACTIC CLLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHALYMAR C TROUMBLY D.C. (OWNER)
(218) 326-1104
Entity
Organization
Contact information
Practice address
2412 N.E. 27TH AVENUE, GRAND RAPIDS, MN 55744-5793
(218) 326-1104
Mailing address
2412 N.E. 27TH AVENUE, GRAND RAPIDS, MN 55744-5793
(218) 326-1104
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3659
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
281M0LI
BCBSM CONTRACTING PROVIDER
MN
01
—
291M7NE
BCBSM INDIVIDUAL PROVIDER
MN
01
—
350003063
MEDICARE
MN
01
—
456719600
MDHS
MN
01
—
CC10368
CHIROPRACTIC CARE OF MN
MN
Enumeration date
04/10/2013
Last updated
04/10/2013
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