Provider Demographics
NPI:1154752640
Name:SIVERTSEN, LINDSEY MARIE (DC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:SIVERTSEN
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 1:40977 277TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-5622
Mailing Address - Country:US
Mailing Address - Phone:605-661-9639
Mailing Address - Fax:
Practice Address - Street 1:1605 MAIN ST.
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066
Practice Address - Country:US
Practice Address - Phone:605-384-5419
Practice Address - Fax:605-384-5410
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS108034OtherMEDICARE PTAN