Lidstrom, Jennifer Marie

Lidstrom, Jennifer Marie is an sole proprietor health care provider with primary practice located at 19924 Jetton Rd Suite 101, Cornelius NC 28031-8250. She recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as her primary health care specialty. Lidstrom, Jennifer Marie can be contacted via phone (704) 876-8446.

Contact Information

Primary practice address
19924 Jetton Rd Suite 101 Cornelius NC 28031-8250
Phone: (704) 876-8446
Fax: (704) 896-8495
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 3249 North Carolina

Profile Details

NPI number 1073618708
LBN Legal business name Lidstrom, Jennifer Marie
Credentials M.S.,D.C.,P.C.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 14th, 2006
Last updated May 15th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073618708 NPPES
North Carolina MEDICAID 89085RN

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