Organization
LAKE CITY CHIROPRACTIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEROY FRANK OTTO D.C. (PRESIDENT)
(651) 345-3361
Entity
Organization
Contact information
Practice address
127 S HIGH ST, LAKE CITY, MN 55041-1637
(651) 345-3361
(651) 345-4049
Mailing address
127 S HIGH ST, LAKE CITY, MN 55041-1637
(651) 345-3361
(651) 345-4049
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3W422
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36065OT
BCBS#LEROY F. OTTO,D.C.
MN
01
—
36162OT
BCBS#LAKE CITY CHIROPRACT
MN
Enumeration date
11/20/2006
Last updated
08/22/2020
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