Robert Donald Waddell III, D.C.
Individual provider Active NPI Chiropractor · Lindstrom, MN
NPI 1033445218 · NPPES record last updated Feb 12, 2020
Key facts
- NPI
- 1033445218
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5301 (MN)
- Practice address
- 12099 Lake Blvd
Lindstrom, MN 55045-9322 - Phone
- (651) 257-1103
- Fax
- (651) 257-1552
- NPI assigned
- Oct 23, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
12099 Lindstrom LN
Lindstrom, MN 55045-9543
Phone (651) 257-1103
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100331000986 | MN | Practitioner - Chiropractic | 0547396368 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5301 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lindstrom Chiropractic Center, PA | Chiropractor | Current |
Accepting new patients |
| Lindstrom Chiropractic Center, P.a. | Chiropractor | Current | Accepting new patients |
Locations
12099 Lindstrom Ln
Lindstrom, MN 55045
Phone (651) 243-8967
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5301 | MN | Yes |
Addresses
Primary practice location
12099 Lake Blvd
Lindstrom, MN 55045-9322
Mailing address
12099 Lindstrom LN
Lindstrom, MN 55045-9543
Phone (651) 257-1103
Other providers in Lindstrom, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.