Provider Demographics
NPI:1700919032
Name:LEE-FUHR CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:LEE-FUHR CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:YOUNGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-235-5444
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-1536
Mailing Address - Country:US
Mailing Address - Phone:320-235-5444
Mailing Address - Fax:320-231-0937
Practice Address - Street 1:180 45TH AVE SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9665
Practice Address - Country:US
Practice Address - Phone:320-235-5444
Practice Address - Fax:320-231-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN230959OtherACN GROUP
MN45160LEOtherBLUECROSSBLUESHIELD OF MN