Lakeside Sports Chiropractic Center
LBN: Jennifer Lidstrom Ms Dc Pc
Lakeside Sports Chiropractic Center is an health care organization with primary practice located at 19924 Jetton Rd Ste 101 , Cornelius NC 28031-8253. The organization recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Chiropractor, Ambulatory Health Care Facilities / Multi-Specialty. Ambulatory Health Care Facilities / Multi-Specialty is the primary health care specialty.
Jennifer Lidstrom Ms Dc Pc can be contacted via phone (704) 896-8446, or through Lidstrom, Jennifer Marie via phone (704) 896-8446.
Contact Information
Primary practice address
19924 Jetton Rd Ste 101
Cornelius NC 28031-8253
Phone: (704) 896-8446
Fax: (704) 896-8495
Website:
Authorized official contact:
Name: Lidstrom, Jennifer Marie Doctor of Chiropractic (DC)
Phone: (704) 896-8446
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 3249 | North Carolina |
| Ambulatory Health Care Facilities / Multi-Specialty | 261QM1300X |
Profile Details
| NPI number | 1033125240 |
|---|---|
| LBN Legal business name | Jennifer Lidstrom Ms Dc Pc |
| DBA Doing business as | Lakeside Sports Chiropractic Center |
| Authorized official | Lidstrom, Jennifer Marie Doctor of Chiropractic (DC) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jul 31st, 2006 |
| Last updated | May 17th, 2022 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1033125240 | NPPES |
| North Carolina | MEDICAID | 89085RM |
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