Provider Demographics
NPI:1689740268
Name:SIKORSKI, MARI A (DC)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:A
Last Name:SIKORSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:A
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6631 LOCHANBURN ROAD
Mailing Address - Street 2:UNIT B
Mailing Address - City:EDEN PRARIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-2050
Mailing Address - Country:US
Mailing Address - Phone:952-937-1188
Mailing Address - Fax:952-294-8536
Practice Address - Street 1:6631 LOCHANBURN ROAD
Practice Address - Street 2:UNIT B
Practice Address - City:EDEN PRARIE
Practice Address - State:MN
Practice Address - Zip Code:55346-2050
Practice Address - Country:US
Practice Address - Phone:952-937-1188
Practice Address - Fax:952-294-8536
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4482549OtherMEDICA
MN3K883REOtherBCBS
U31116Medicare UPIN