Organization
SPORTWORKS ACTIVE CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM LEZON D.C. (OWNER)
(612) 486-5554
Entity
Organization
Contact information
Practice address
1629 HENNEPIN AVE, SUITE 250, MINNEAPOLIS, MN 55403-1742
(612) 486-5554
Mailing address
1629 HENNEPIN AVE, SUITE 250, MINNEAPOLIS, MN 55403-1742
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5931
MN
Other
Enumeration date
06/12/2014
Last updated
10/19/2015
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