Provider Demographics
NPI:1922646223
Name:LEE, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 SCOTT TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4041
Mailing Address - Country:US
Mailing Address - Phone:651-454-1000
Mailing Address - Fax:
Practice Address - Street 1:4590 SCOTT TRL STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4041
Practice Address - Country:US
Practice Address - Phone:651-454-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1396828299OtherACU-CHIROPRACTIC WELLNESS CENTER, P.A.