Provider Demographics
NPI:1528145349
Name:LINDHOLM, MARK ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:LINDHOLM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3418
Mailing Address - Country:US
Mailing Address - Phone:574-262-4402
Mailing Address - Fax:574-264-0778
Practice Address - Street 1:601 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3418
Practice Address - Country:US
Practice Address - Phone:574-262-4402
Practice Address - Fax:574-264-0778
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001457A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000269183OtherBCBS
IN000000269183OtherBCBS
IN228470Medicare ID - Type Unspecified