Provider Demographics
NPI:1679845960
Name:LACEE N CARR
Entity Type:Organization
Organization Name:LACEE N CARR
Other - Org Name:FULL CIRCLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LACEE
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-774-5036
Mailing Address - Street 1:34 24TH ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6271
Mailing Address - Country:US
Mailing Address - Phone:701-774-5036
Mailing Address - Fax:701-774-5037
Practice Address - Street 1:34 24TH ST W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6271
Practice Address - Country:US
Practice Address - Phone:701-774-5036
Practice Address - Fax:701-774-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1679845960OtherBLUE CROSS BLUE SHIELD
ND1679845960OtherMEDICARE