Provider Demographics
NPI:1518111665
Name:LECY FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LECY FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LECY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-718-5329
Mailing Address - Street 1:325 OMAHA ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2803
Mailing Address - Country:US
Mailing Address - Phone:605-718-5329
Mailing Address - Fax:605-718-5334
Practice Address - Street 1:325 OMAHA ST STE 5
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2850
Practice Address - Country:US
Practice Address - Phone:605-718-5329
Practice Address - Fax:605-718-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602530Medicaid
SD7600672Medicaid