Provider Demographics
NPI:1992944425
Name:SUSAN LECY-LINDALL
Entity type:Organization
Organization Name:SUSAN LECY-LINDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LECY-LINDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-2409
Mailing Address - Street 1:1750 TOWER BLVD
Mailing Address - Street 2:SUITE 203 P.O. BOX 42
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-4566
Mailing Address - Country:US
Mailing Address - Phone:952-442-2409
Mailing Address - Fax:
Practice Address - Street 1:1750 TOWER BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-4566
Practice Address - Country:US
Practice Address - Phone:952-442-2409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN234878100Medicaid
MN350002813Medicare PIN