Provider Demographics
NPI:1619178928
Name:LECY-LINDALL, SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:LECY-LINDALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LECY-LINDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:836 RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315
Mailing Address - Country:US
Mailing Address - Phone:952-442-2409
Mailing Address - Fax:952-442-2987
Practice Address - Street 1:836 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MN
Practice Address - Zip Code:55315-4515
Practice Address - Country:US
Practice Address - Phone:952-442-2409
Practice Address - Fax:952-442-2987
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN610837OtherACN CCMI
MN350002111Medicare ID - Type Unspecified