MEDICARE: DR. MARK W LAMPMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1438	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39454LA	OTHER	MN	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1912016130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W LAMPMAN DC

Provider Business Mailing Address
First Line	:	5188 CENTRAL AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1825
Country	:	US
Telephone Number	:	763-571-8960
Fax Number	:	763-571-2754

Provider Business Practice Location Address
First Line	:	5188 CENTRAL AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-1825
Country	:	US
Telephone Number	:	763-571-8960
Fax Number	:	763-571-2754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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