DR. JENNIFER MARIE LIDSTROM (NPI# 1073618708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073618708 |
| Entity Type | Individual |
| Full Name | DR. JENNIFER MARIE LIDSTROM |
| Credential | M.S.,D.C.,P.C. |
| Practice Address |
19924 Jetton Rd Suite 101 Cornelius NC 28031-8250 |
| Practice Telephone | 7048768446 |
| Practice Fax Number | 7048968495 |
| Mailing Telephone | 7048768446 |
| Mailing Fax Number | 7048968495 |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-05-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 3249 | NC | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89085RN | 05 |
| Street Address |
19924 JETTON RD SUITE 101 |
| City | CORNELIUS |
| State | NC |
| Zip Code | 28031-8250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013202639 | Laura Anne Jussila Watterson | Chiropractor | 19924 Jetton Rd, Cornelius, NC 28031-8250 | 2011-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827221 | Jessica Leigh Akbari | Behavior Technician | 16915 Liverpool Pkwy. Suite B, Cornelius, NC 28031 | 2020-10-02 |
| 1548871569 | Aalasa Brooks | Behavior Technician | 16915 Liverpool Pkwy, Suite B, Cornelius, NC 28031 | 2020-08-13 |
| 1366053381 | Mary-clara Pearl Mcalister | Behavior Technician | 16915 Liverpool Parkway, Suite B, Cornelius, NC 28031 | 2020-08-13 |
| 1851926075 | Cherie Torrence | Acupuncturist | 16930 W. Catawba Ave 203, Cornelius, NC 28031 | 2020-03-09 |
| 1154970481 | 100 Percent Chiropractic Padilla, LLC | Chiropractor | 19722 One Norman Drive, Suite 210, Cornelius, NC 28031 | 2019-09-09 |
| 1528628526 | O'brien and West, Dmd Viii, Pllc | Dentist | 19911 Zion Ave Bldg D, Ste. #d4, Cornelius, NC 28031 | 2019-06-20 |
| 1548775182 | Gretchen Anthony | Social Worker | 17105 Kenton Drive, Suite 201c, Cornelius, NC 28031 | 2017-12-05 |
| 1669842076 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 21720 Catawba Ave, Cornelius, NC 28031 | 2015-09-28 |
| 1518336296 | Special Touch Living | Clinic/Center | 11262 Heritage Green Drive, Cornelius, NC 28031 | 2015-09-23 |
| 1568830917 | Michelle Rene Skaggs | Occupational Therapist | 9075 Rosalyn Glen Rd, Cornelius, NC 28031 | 2015-09-02 |
| Find all providers in zip 28031 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396360210 | Urban Health Chiropractic LLC | Chiropractor | 1610 N Adair St Ste D, Cornelius, OR 97113-8832 | 2020-06-16 |
| 1548806706 | Optimize Chiropractic, Pllc | Chiropractor | 19109 W Catawba Ave Ste 100, Cornelius, NC 28031-5611 | 2019-11-22 |
| 1518500834 | William J Wallace Jr. | Chiropractor | 22415 Market St Apt 1406, Cornelius, NC 28031-3028 | 2019-10-18 |
| 1154970481 | 100 Percent Chiropractic Padilla, LLC | Chiropractor | 19722 One Norman Drive, Suite 210, Cornelius, NC 28031 | 2019-09-09 |
| 1578078861 | Jannette Rodriguez | Chiropractor | 19109 W Catawba Ave Ste 106, Cornelius, NC 28031-5612 | 2017-12-07 |
| 1801306717 | Benjamin Haynes | Chiropractor | 19315 W Catawba Ave Ste 100, Cornelius, NC 28031-5637 | 2017-10-05 |
| 1538527759 | Christopher Davis | Chiropractor | 20420 W Catawba Ave, Cornelius, NC 28031-5259 | 2016-02-02 |
| 1124385844 | Eric Wayne Goodman | Chiropractor | 18047 W Catawba Ave Ste A, Cornelius, NC 28031-5663 | 2012-04-19 |
| 1538465414 | Jennifer D Smith | Chiropractor | 20124 W Catawba Ave Ste B, Cornelius, NC 28031-4078 | 2011-02-10 |
| 1235469412 | Heymi Hamlin | Chiropractor | 1250 Baseline St., Cornelius, OR 97113 | 2010-01-11 |
| Find all providers in CORNELIUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.