Healthcare Provider Details

I. General information

NPI: 1588651038
Provider Name (Legal Business Name): ALA LORA LYSYK SMITH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W LINCOLN AVE
FERGUS FALLS MN
56537-2123
US

IV. Provider business mailing address

104 W LINCOLN AVE
FERGUS FALLS MN
56537-2123
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-4113
  • Fax: 218-998-4337
Mailing address:
  • Phone: 218-736-4113
  • Fax: 218-998-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3238
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: