Provider Demographics
NPI:1245558683
Name:BRINCEFIELD, LOGAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:LEE
Last Name:BRINCEFIELD
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 1:306 W HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:NORWOOD YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55368-9775
Mailing Address - Country:US
Mailing Address - Phone:952-467-2132
Mailing Address - Fax:
Practice Address - Street 1:306 W HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368-9775
Practice Address - Country:US
Practice Address - Phone:952-467-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor