Provider Demographics
NPI:1336380005
Name:LEFTWICH, BYRON LEE (LAC)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:LEE
Last Name:LEFTWICH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3583 GARDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128
Mailing Address - Country:US
Mailing Address - Phone:541-206-1077
Mailing Address - Fax:
Practice Address - Street 1:137 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1502
Practice Address - Country:US
Practice Address - Phone:763-689-2462
Practice Address - Fax:763-689-1688
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist