Provider Demographics
NPI:1780753475
Name:PLCC, LTD
Entity type:Organization
Organization Name:PLCC, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:STICHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-447-8980
Mailing Address - Street 1:14020 HIGHWAY 13 S
Mailing Address - Street 2:SUITE 650
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-7100
Mailing Address - Country:US
Mailing Address - Phone:952-447-8980
Mailing Address - Fax:952-447-8941
Practice Address - Street 1:14020 HIGHWAY 13 S
Practice Address - Street 2:SUITE 650
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-7100
Practice Address - Country:US
Practice Address - Phone:952-447-8980
Practice Address - Fax:952-447-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN75172PROtherBLUE CROSS BLUE SHILED
MN69944580Medicaid
MNC02402Medicare ID - Type Unspecified