MEDICARE: LEGACY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4689	MN

General Provider Information

NPI Number	:	1659588242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	210 N 2ND ST STE 103
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1439
Country	:	US
Telephone Number	:	612-922-2225
Fax Number	:	612-746-0501

Provider Business Practice Location Address
First Line	:	4567 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3702
Country	:	US
Telephone Number	:	702-368-3463
Fax Number	:	702-368-0027

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SANDRA RAMSEY
Credential	:
Telephone Number	:	612-922-2225

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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Directions to “LEGACY CHIROPRACTIC ” Practice Location

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