Provider Demographics
NPI:1437289964
Name:MINNAERT, LEEANN FAY (DC)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:FAY
Last Name:MINNAERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WEST BURNSVILLE PARKWAY
Mailing Address - Street 2:SUITE 156
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-210-2364
Mailing Address - Fax:
Practice Address - Street 1:201 WEST BURNSVILLE PARKWAY
Practice Address - Street 2:SUITE 156
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-210-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor