Healthcare Provider Details

I. General information

NPI: 1700919032
Provider Name (Legal Business Name): LEE-FUHR CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 45TH AVE SE
WILLMAR MN
56201-9665
US

IV. Provider business mailing address

PO BOX 1536
WILLMAR MN
56201-1536
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-5444
  • Fax: 320-231-0937
Mailing address:
  • Phone: 320-235-5444
  • Fax: 320-231-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2415
License Number StateMN

VIII. Authorized Official

Name: DR. MICHAEL W YOUNGQUIST
Title or Position: PRESIDENT
Credential: DC
Phone: 320-235-5444