| Jennifer Lidstrom Ms Dc Pc | |
|
19924 Jetton Rd Ste 101, Cornelius, NC 28031-8253 | |
| (704) 896-8446 | |
| (704) 896-8495 |
| Full Name | Jennifer Lidstrom Ms Dc Pc |
|---|---|
| Type | Facility |
| Speciality | Clinic/center - Multi-specialty |
| Location | 19924 Jetton Rd Ste 101, Cornelius, North Carolina |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033125240 | NPI | - | NPPES |
| 89085RM | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 3249 (North Carolina) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jennifer M Lidstrom |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1073618708 PECOS PAC ID: 1759356991 Enrollment ID: I20040831000820 |
| Provider Name | Luis Alejandro Rosado |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1124430301 PECOS PAC ID: 9739474834 Enrollment ID: I20181116000586 |
| Provider Name | Suzanne Dudko |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1538246897 PECOS PAC ID: 8224060652 Enrollment ID: I20200610003057 |
| Provider Name | Brian Otis Nappier |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437678877 PECOS PAC ID: 2062829468 Enrollment ID: I20210401000075 |
| Provider Name | Dakota Powell Vance |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1194480053 PECOS PAC ID: 6204225048 Enrollment ID: I20211116002057 |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Lidstrom Ms Dc Pc 19924 Jetton Rd Ste 101, Cornelius, NC 28031-8253 Ph: (704) 896-8446 | Jennifer Lidstrom Ms Dc Pc 19924 Jetton Rd Ste 101, Cornelius, NC 28031-8253 Ph: (704) 896-8446 |