Provider Demographics
NPI:1639109598
Name:LECY, ROBIN R (DC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:R
Last Name:LECY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 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
Practice Address - Street 2:SUITE 5
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2803
Practice Address - Country:US
Practice Address - Phone:605-718-5329
Practice Address - Fax:605-718-5334
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD00008457OtherBLUE CROSS BLUE SHIELD
SD7600672Medicaid
SD8573Medicare ID - Type Unspecified
SD00008457OtherBLUE CROSS BLUE SHIELD