DR. LEROY FRANK OTTO (NPI# 1497813083) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497813083 |
| Entity Type | Individual |
| Full Name | DR. LEROY FRANK OTTO |
| Credential | DC |
| Practice Address |
127 South High Street Lake City MN 55041-1637 |
| Practice Telephone | 6513453361 |
| Practice Fax Number | 6513454049 |
| Mailing Telephone | 6513453361 |
| Mailing Fax Number | 6513454049 |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | 857CHI | MT | Chiropractic Providers |
| N | 111N00000X | Chiropractor | 1381 | WI | Chiropractic Providers |
| Y | 111N00000X | Chiropractor | 1417 | MN | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | 36065OT | 01 |
| Street Address |
127 SOUTH HIGH STREET |
| City | LAKE CITY |
| State | MN |
| Zip Code | 55041-1637 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285136242 | Perry Dental, Ltd. | Dentist | 210 N. Lakeshore Dr., Lake City, MN 55041 | 2018-03-06 |
| 1790182335 | Innovative Chiropractic Center | Chiropractor | 201 D East Ave., Red Wing, MN 55041 | 2014-11-25 |
| 1245327147 | David F Valkos | Chiropractor | 106 So Washington St, Lake City, MN 55041 | 2006-10-10 |
| 1063441830 | Michael D Ackermann | Optometrist | 117 W Center St, Lake City, MN 55041 | 2006-07-02 |
| 1871945469 | Heidi Ann Eisenman | Nurse Practitioner | 500 W Grant St, Lake City, MN 55041 | 2016-07-07 |
| 1760668693 | Elizabeth Agnes Olson | Chiropractor | 106 S Washington St, Lake City, MN 55041-1034 | 2008-01-10 |
| 1194900936 | Valkos Chiropractic Office, LLC | Clinic/Center | 106 S Washington St, Lake City, MN 55041-1034 | 2007-12-28 |
| 1689650350 | Ann Marie Lowe | Family Medicine | 500 W Grant St, Lake City, MN 55041-1143 | 2005-12-15 |
| 1689280406 | Kelly Marie Kennedy | Pharmacist | 500 W Grant St, Lake City, MN 55041-1143 | 2020-09-17 |
| 1447863972 | Mayo Clinic Health System-lake City | Non-Pharmacy Dispensing Site | 500 W Grant St, Lake City, MN 55041-1143 | 2020-08-25 |
| Find all providers in zip 55041 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194295592 | Joshua M Wilson | Chiropractor | 444 Sw Alachua Avenue, Lake City, FL 32025-5213 | 2018-11-28 |
| 1487018222 | Lake City Spine & Injury, LLC | Chiropractor | 2057 Sw Main Blvd, Lake City, FL 32025-0021 | 2016-04-07 |
| 1841656527 | Chucky Sentell Jordan | Chiropractor | 263 Kelley St Ste 100, Lake City, SC 29560-2472 | 2016-01-11 |
| 1811179781 | Lake City Chiropractic and Massage | Chiropractor | 512 W Duval St, Lake City, FL 32055-3899 | 2007-12-03 |
| 1003000415 | Marshall Dean Webster | Chiropractor | 1478 Sw Sisters Welcome Rd, Lake City, FL 32025-1607 | 2007-08-29 |
| 1649481052 | Larry Fredric Radke | Chiropractor | 430 Sw Columbia Ave, Lake City, FL 32025-5254 | 2007-05-25 |
| 1356481386 | Shawn A Stephens | Chiropractor | 935 Sw Baya Dr, Lake City, FL 32025-4210 | 2007-02-07 |
| 1033266317 | Nathan Troy Schulz | Chiropractor | 925 S Oak St, Lake City, MN 55041-1856 | 2007-01-05 |
| 1205990066 | Terrell E Fowler IIi | Chiropractor | 111 N Matthews Rd, Lake City, SC 29560-2309 | 2006-12-19 |
| 1376618793 | Charles Watts | Chiropractor | 5499 Jonesboro Rd, Lake City, GA 30260-3553 | 2006-11-21 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.