Lighthouse Chiropractic Cllinic, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3659 Issued in MN

Legal business name

LIGHTHOUSE CHIROPRACTIC CLLINIC, PLLC

Practice address

2412 N.E. 27TH Avenue
Grand Rapids, MN 55744-5793

Phone

(218) 326-1104

NPI assigned

Apr 10, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Shalymar C Troumbly, D.C.

Title

Owner

Phone

(218) 326-1104

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1952744831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 N.E. 27TH AVENUE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557445793",
            "telephone_number": "218-326-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 N.E. 27TH AVENUE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557445793",
            "telephone_number": "218-326-1104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE CHIROPRACTIC CLLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-10",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "TROUMBLY",
        "authorized_official_first_name": "SHALYMAR",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-326-1104",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM CONTRACTING PROVIDER",
            "identifier": "281M0LI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDHS",
            "identifier": "456719600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC CARE OF MN",
            "identifier": "CC10368",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM INDIVIDUAL PROVIDER",
            "identifier": "291M7NE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "350003063",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lee D Jess DDS LTD
• Micayla Frances-Kate Lessard
• Sarah Jean Levar
• Simon Leo Lick, M.D.
• Michael B. Liebe, MD
• Danielle Lee Lindner, LICSW
• Mackenzie Paige Lindquist, DPT
• Mary Ellen Linnihan, MA, LP
• Tabbatha Jo Litchke Herdman, MS ED, LPCC
• Sarah Jayne Litchke, LADC

• Chiropractor in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.