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General NPI Number Information
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NPI Number | 1992879134
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Entity Type | Organization
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Legal Business Name | LAKE CITY CHIROPRACTIC, LTD.
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 127 S HIGH ST
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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 S HIGH ST
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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 | PRESIDENT
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Name | DR. LEROY FRANK OTTO
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Credential | D.C.
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Telephone | 651-345-3361
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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 | 3W422
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License Number State | MN
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