JENNIFER LIDSTROM MS DC PC NPI 1033125240

NPI Information

NPI: 1033125240
Provider Name: JENNIFER LIDSTROM MS DC PC

Doing Business As: LAKESIDE SPORTS CHIROPRACTIC CENTER

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
19924 JETTON RD STE 101
CORNELIUS, NC
ZIP 28031
Phone: (704) 896-8446
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JENNIFER LIDSTROM MS DC PC is a multi-specialty clinic center in Cornelius, NC. JENNIFER LIDSTROM MS DC PC NPI is 1033125240. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Lakeside Sports Chiropractic Center.

The provider's business location address is:

19924 JETTON RD STE 101
CORNELIUS, NC
ZIP 28031-253
Phone: (704) 896-8446
Fax: (704) 896-8495

The provider's authorized official is Jennifer Marie Lidstrom .
The authorized official title is Managing Member and has the following contact phone number (704) 896-8446.

The enumeration date for this NPI number is 7/31/2006 and was last updated on 5/17/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		3249	NORTH CAROLINA	No
2	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	89085RM	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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