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General NPI Number Information
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NPI Number | 1265677587
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Entity Type | Individual
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Provider Name | CORY SHANE LINDSTROM D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 5216 E. CLEVELAND BLVD STE G
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City | CALDWELL
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State | ID
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Zip | 83607
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Country | US
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Telephone | 208-454-5500
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Fax | 208-454-8877
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Provider Business Mailing Address
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Address Line | 5216 E. CLEVELAND BLVD. STE G
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City | CALDWELL
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State | ID
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Zip | 83607
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Country | US
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Telephone | 208-454-5500
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Fax | 208-454-8877
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1335
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License Number State | ID
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