Healthcare Provider Details

I. General information

NPI: 1275539900
Provider Name (Legal Business Name): LEE-ANN CHARLENE MARCHWICK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEE-ANN CHARLENE BURNS D.C.

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 STATE 371 NW 2
HACKENSACK ME
56452-0004
US

IV. Provider business mailing address

PO BOX 4
HACKENSACK MN
56452
US

V. Phone/Fax

Practice location:
  • Phone: 218-675-5768
  • Fax:
Mailing address:
  • Phone: 218-675-5768
  • Fax: 218-829-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4295
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier105879700
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 2
Identifier386M0BU
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: