Provider Demographics
NPI:1083903918
Name:FIXEN, LEE (DC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:FIXEN
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 1:104 W REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1980
Mailing Address - Country:US
Mailing Address - Phone:507-532-2655
Mailing Address - Fax:507-532-2951
Practice Address - Street 1:104 W REDWOOD ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1980
Practice Address - Country:US
Practice Address - Phone:507-532-2655
Practice Address - Fax:507-532-2951
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011683111N00000X
MN6626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor