Provider Demographics
NPI:1275539900
Name:MARCHWICK, LEE-ANN CHARLENE (DC)
Entity Type:Individual
Prefix:MRS
First Name:LEE-ANN
Middle Name:CHARLENE
Last Name:MARCHWICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LEE-ANN
Other - Middle Name:CHARLENE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:MN
Mailing Address - Zip Code:56452
Mailing Address - Country:US
Mailing Address - Phone:218-675-5768
Mailing Address - Fax:218-829-8201
Practice Address - Street 1:3065 STATE 371 NW 2
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:ME
Practice Address - Zip Code:56452-0004
Practice Address - Country:US
Practice Address - Phone:218-675-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105879700Medicaid
MN386M0BUOtherBCBS
MN350003255Medicare ID - Type Unspecified
MN105879700Medicaid
MN386M0BUOtherBCBS