Provider Demographics
NPI:1518179688
Name:LEQUIRE, STACY ANN KACZMAREK (DC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN KACZMAREK
Last Name:LEQUIRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:KACZMAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2625 HIGHWAY 14 W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7597
Mailing Address - Country:US
Mailing Address - Phone:507-208-4538
Mailing Address - Fax:
Practice Address - Street 1:2625 HIGHWAY 14 W STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7597
Practice Address - Country:US
Practice Address - Phone:507-208-4538
Practice Address - Fax:507-208-4539
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3022111N00000X
MN4092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU92930Medicare UPIN
MN350003086Medicare ID - Type Unspecified