Healthcare Provider Details

I. General information

NPI: 1346249679
Provider Name (Legal Business Name): THOMAS JOHN LINDSTROM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 W DOWNER PL STE 201
AURORA IL
60506-4379
US

IV. Provider business mailing address

1965 W DOWNER PL STE 201
AURORA IL
60506-4379
US

V. Phone/Fax

Practice location:
  • Phone: 630-896-3377
  • Fax: 630-896-2120
Mailing address:
  • Phone: 630-896-3377
  • Fax: 630-896-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-004507
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: