Provider Demographics
NPI:1780851030
Name:LELWICA CHIROPRACTIC
Entity Type:Organization
Organization Name:LELWICA CHIROPRACTIC
Other - Org Name:HOPKINS HEALTH AND WELLNESS LAKES AREA
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-568-5648
Mailing Address - Street 1:31108 GOVERNMENT DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-1001
Mailing Address - Country:US
Mailing Address - Phone:218-568-5648
Mailing Address - Fax:218-568-5698
Practice Address - Street 1:31108 GOVERNMENT DR
Practice Address - Street 2:SUITE 108
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-1001
Practice Address - Country:US
Practice Address - Phone:218-568-5648
Practice Address - Fax:218-568-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU52639Medicare UPIN