Lake And Leaf Chiropractic Pllc | |
12818 Lake Blvd Lindstrom MN 55045 | |
(651) 257-2300 | |
(651) 257-2333 |
Full Name | Lake And Leaf Chiropractic Pllc |
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Speciality | Clinic/Center |
Location | 12818 Lake Blvd, Lindstrom, Minnesota |
Authorized Official Name and Position | Eric Jon Gormanson (OWNER) |
Authorized Official Contact | 6512572300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lake And Leaf Chiropractic Pllc 12818 Lake Blvd Lindstrom MN 55045 Ph: (651) 257-2300 | Lake And Leaf Chiropractic Pllc 12818 Lake Blvd Lindstrom MN 55045 Ph: (651) 257-2300 |
NPI Number | 1669193793 |
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Provider Enumeration Date | 09/07/2022 |
Last Update Date | 12/13/2022 |
Medicare PECOS PAC ID | 5496125973 |
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Medicare Enrollment ID | O20221227000988 |
Identifier | Type | State | Issuer |
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1669193793 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Eric Gormanson |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1023157831 PECOS PAC ID: 6608970629 Enrollment ID: I20221227001102 |
Lindstrom Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12375 Lindstrom Ln, Lindstrom, MN 55045 Phone: 651-400-2240 Fax: 715-483-0507 |