Healthcare Provider Details

I. General information

NPI: 1447440722
Provider Name (Legal Business Name): LINDBERG CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 98TH ST
BLOOMINGTON MN
55420-3820
US

IV. Provider business mailing address

200 W 98TH ST
BLOOMINGTON MN
55420-3820
US

V. Phone/Fax

Practice location:
  • Phone: 952-881-4421
  • Fax:
Mailing address:
  • Phone: 952-881-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1659
License Number StateMN

VIII. Authorized Official

Name: DR. BRUCE A LINDBERG
Title or Position: OWNER
Credential: DC
Phone: 952-881-4421