Doctor Name: | DR. JENNIFER MARIE LIDSTROM |
NPI Number: | 1073618708 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.,D.C.,P.C. |
License Number: | 3249 |
Business Practice Address: | 19924 Jetton Rd Suite 101 Cornelius, NC - 280318250 |
Business Phone Number: | 7048768446 |
Business Fax Number: | 7048968495 |
Mailing Address: | 19924 Jetton Rd, Suite 101 CORNELIUS |
State: | NC |
Postal Code: | 280318250 |
Phone Number: | 7048768446 |
Fax Number: | 7048968495 |
NPI Enumeration Date: | 09/14/2006 |
NPI Last Update Date: | 01/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 3249 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |