Sportworks Active Chiropractic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5931 Issued in MN

Legal business name

SPORTWORKS ACTIVE CHIROPRACTIC, LLC

Practice address

1629 Hennepin Ave
Suite 250
Minneapolis, MN 55403-1742

Phone

(612) 486-5554

NPI assigned

Jun 12, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sam Lezon, D.C.

Title

Owner

Phone

(612) 486-5554

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445212800000",
    "number": "1114331667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1629 HENNEPIN AVE",
            "address_2": "SUITE 250",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554031742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 HENNEPIN AVE",
            "address_2": "SUITE 250",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554031742",
            "telephone_number": "612-486-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTWORKS ACTIVE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2015-10-19",
        "status": "A",
        "authorized_official_last_name": "LEZON",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-486-5554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Daniel Spoerke, RN
• Richard S Spong, M.D.
• Scott Sponheim
• Steve Carl Spoolman, P.T.
• Michele Roxanne Spoont, PHD
• Carly Rae Spotts-Falzone
• Natalie Spotts
• William B Spray I
• Michael Robert Sprehe, MD
• Mark D Sprenkle, MD

• Chiropractor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.