Jennifer Marie Lidstrom, M.S.,D.C.,P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3249 Issued in NC

Practice address

19924 Jetton Rd
Suite 101
Cornelius, NC 28031-8250

Phone

(704) 876-8446

Fax

(704) 896-8495

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jennifer Lidstrom Ms, DC, PCGroup PAC ID 8921012709, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jennifer Lidstrom Ms DC PC

  • Multi-Specialty Clinic/Center
  • Cornelius, NC
  • NPI 1033125240

  Chiropractor

  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589500800000",
    "number": "1073618708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19924 JETTON RD",
            "address_2": "SUITE 101",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318250",
            "telephone_number": "704-876-8446",
            "fax_number": "704-896-8495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19924 JETTON RD",
            "address_2": "SUITE 101",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280318250",
            "telephone_number": "704-876-8446",
            "fax_number": "704-896-8495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDSTROM",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.S.,D.C.,P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085RN",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Plerticia Lee
• Regina Mae Lefauve, OTR/L
• Tashera Nicole Leonard, LCSWA
• Adam Michael Levine, MSW
• Stephanie Levy, LCMHCA, NCC
• Lifeline Chiropractic, PLLC.
• Sharon Virginia Linder Harrison
• Lee B Lindquist, M.D.
• Lindsey Morgan PLLC
• Lisa Moore, PT, DPT Corporation

• Chiropractor in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.