Lake City Chiropractic, LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3W422 Issued in MN

Legal business name

LAKE CITY CHIROPRACTIC, LTD.

Practice address

127 S High St
Lake City, MN 55041-1637

Phone

(651) 345-3361

Fax

(651) 345-4049

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Leroy Frank Otto, D.C.

Title

President

Phone

(651) 345-3361

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992879134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S HIGH ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411637",
            "telephone_number": "651-345-3361",
            "fax_number": "651-345-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S HIGH ST",
            "city": "LAKE CITY",
            "state": "MN",
            "postal_code": "550411637",
            "telephone_number": "651-345-3361",
            "fax_number": "651-345-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY CHIROPRACTIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OTTO",
        "authorized_official_first_name": "LEROY",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-345-3361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3W422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS#LEROY F. OTTO,D.C.",
            "identifier": "36065OT",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS#LAKE CITY CHIROPRACT",
            "identifier": "36162OT",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Marie Kennedy
• Mark Thomas Kennedy
• Scott Alan Knudsen, DDS
• McKenzie Marie Koch, OTD, OTR/L
• Lake City #813
• Lake City Dental P.L.L.C.
• Jody Leise, APRN, CNS
• Katherine Lillie Lofberg, FNP-C
• Ann Marie Lowe, M.D.
• Reid Lundell

• Chiropractor in Lake City, MN
• Providers in Lake City, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.