Provider Demographics
NPI:1225198856
Name:CICH CHIROPRACTIC
Entity Type:Organization
Organization Name:CICH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-420-2226
Mailing Address - Street 1:13563 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4409
Mailing Address - Country:US
Mailing Address - Phone:763-420-2226
Mailing Address - Fax:763-420-5604
Practice Address - Street 1:13563 GROVE DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4409
Practice Address - Country:US
Practice Address - Phone:763-420-2226
Practice Address - Fax:763-420-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03115Medicare ID - Type Unspecified