Provider Demographics
NPI:1235495615
Name:VANSICKLER, CYNTHIA SUSANNA (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUSANNA
Last Name:VANSICKLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:SUSANNA
Other - Last Name:ECKERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:725 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5065
Mailing Address - Country:US
Mailing Address - Phone:515-570-7695
Mailing Address - Fax:
Practice Address - Street 1:9202 202ND ST W
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7915
Practice Address - Country:US
Practice Address - Phone:952-469-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor