Provider Demographics
NPI:1366529554
Name:DOBBERSTEIN, LINDA J (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:DOBBERSTEIN
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 1:9940 PENN AVE S APT 5
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2928
Mailing Address - Country:US
Mailing Address - Phone:612-616-5452
Mailing Address - Fax:
Practice Address - Street 1:8609 LYNDALE AVE S
Practice Address - Street 2:SUITE 213B
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2754
Practice Address - Country:US
Practice Address - Phone:612-616-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3958111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003224Medicare ID - Type Unspecified
MNV02444Medicare UPIN