Provider Demographics
NPI:1447267075
Name:LINDBERG, CHARLENE MARY (DC)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARY
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13955 W PRESERVE BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7733
Mailing Address - Country:US
Mailing Address - Phone:952-890-5694
Mailing Address - Fax:952-890-1095
Practice Address - Street 1:13955 W PRESERVE BLVD # 200
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-7733
Practice Address - Country:US
Practice Address - Phone:952-890-5694
Practice Address - Fax:952-890-1095
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00610076OtherGROUP MEMBER PTAN (RAILROAD MEDICARE)
MN776100100Medicaid
MN74P93LIOtherBCBS
MN776100100Medicaid