Provider Demographics
NPI:1881601672
Name:LELWICA, MICHELLE RAE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RAE
Last Name:LELWICA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31108 GOVERNMENT DR
Mailing Address - Street 2:
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-1001
Mailing Address - Country:US
Mailing Address - Phone:218-568-5648
Mailing Address - Fax:218-568-5698
Practice Address - Street 1:31108 GOVERNMENT DR
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-1001
Practice Address - Country:US
Practice Address - Phone:218-568-5648
Practice Address - Fax:218-568-5698
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN137828700Medicaid
MNU52639Medicare UPIN