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General NPI Number Information
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NPI Number | 1497813083
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Entity Type | Individual
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Provider Name | LEROY FRANK OTTO DC
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 127 SOUTH HIGH STREET
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City | LAKE CITY
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State | MN
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Zip | 55041-1637
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Country | US
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Telephone | 651-345-3361
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Fax | 651-345-4049
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Provider Business Mailing Address
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Address Line | 127 SOUTH HIGH STREET
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City | LAKE CITY
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State | MN
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Zip | 55041-1637
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Country | US
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Telephone | 651-345-3361
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Fax | 651-345-4049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1417
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1381
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 857CHI
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License Number State | MT
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