Provider Demographics
NPI:1740225259
Name:LECY, DOUGLAS J (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:LECY
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 1:1406 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4582
Mailing Address - Country:US
Mailing Address - Phone:605-343-7440
Mailing Address - Fax:605-342-7868
Practice Address - Street 1:1406 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4582
Practice Address - Country:US
Practice Address - Phone:605-343-7440
Practice Address - Fax:605-342-7868
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601990Medicaid
SD0100784OtherBLUE CROSS BLUE SHIELD
SD100784Medicare ID - Type Unspecified
SD0100784OtherBLUE CROSS BLUE SHIELD