Provider Demographics
NPI:1306992011
Name:SCHWARTZ, LEE (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3494 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4579
Mailing Address - Country:US
Mailing Address - Phone:651-779-2291
Mailing Address - Fax:
Practice Address - Street 1:4801 HIGHWAY 61 N STE 105
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2748
Practice Address - Country:US
Practice Address - Phone:651-762-5433
Practice Address - Fax:651-762-7504
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN25156795OtherWAUSAU BENEFITS #
MN52D99SCOtherBCBS PROVIDER NUMBER
MNU79624Medicare UPIN
MN350002680Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER