Provider Demographics
NPI:1083644470
Name:GOODSELL, LORI KRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:KRISTINE
Last Name:GOODSELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 ANNAPOLIS LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5379
Mailing Address - Country:US
Mailing Address - Phone:763-553-0387
Mailing Address - Fax:
Practice Address - Street 1:3390 ANNAPOLIS LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5378
Practice Address - Country:US
Practice Address - Phone:763-553-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU80590Medicare UPIN