Provider Demographics
NPI:1770629495
Name:LEGIER, LAWRENCE GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GEORGE
Last Name:LEGIER
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 1:1827 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-7959
Mailing Address - Country:US
Mailing Address - Phone:507-288-8000
Mailing Address - Fax:507-288-0914
Practice Address - Street 1:1827 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7959
Practice Address - Country:US
Practice Address - Phone:507-288-8000
Practice Address - Fax:507-288-0914
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1847111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2937942OtherMINNESOTA TAX ID NUMBER