Healthcare Provider Details

I. General information

NPI: 1891320347
Provider Name (Legal Business Name): LYNDSAY CLOAREC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 33RD AVE N
SAINT CLOUD MN
56303-4846
US

IV. Provider business mailing address

1535 SEVENTH ST S APT 104
SARTELL MN
56377
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-5599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3699
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: