MEDICARE: DR. DOUGLAS J. LECY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1068	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0100784	OTHER	SD	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1740225259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS J. LECY D.C.

Provider Business Mailing Address
First Line	:	1406 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4582
Country	:	US
Telephone Number	:	605-343-7440
Fax Number	:	605-342-7868

Provider Business Practice Location Address
First Line	:	1406 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4582
Country	:	US
Telephone Number	:	605-343-7440
Fax Number	:	605-342-7868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/19/2021

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