Provider Demographics
NPI:1093847808
Name:RETZER, LESTER JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:JOHN
Last Name:RETZER
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 1:8609 LYNDALE AVE S
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2754
Mailing Address - Country:US
Mailing Address - Phone:952-881-0007
Mailing Address - Fax:952-881-0008
Practice Address - Street 1:8609 LYNDALE AVE S
Practice Address - Street 2:SUITE 116
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2754
Practice Address - Country:US
Practice Address - Phone:952-881-0007
Practice Address - Fax:952-881-0008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor