Healthcare Provider Details

I. General information

NPI: 1154586634
Provider Name (Legal Business Name): LONSDALE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST SO
LONSDALE MN
55046-0162
US

IV. Provider business mailing address

PO BOX 162
LONSDALE MN
55046-0162
US

V. Phone/Fax

Practice location:
  • Phone: 507-744-5514
  • Fax: 507-744-5513
Mailing address:
  • Phone: 507-744-5514
  • Fax: 507-744-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE H LIESKE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 507-744-5514