Provider Demographics
NPI:1023042678
Name:LEE, JEFFREY KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENNETH
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W HOWARD CITY EDMORE RD
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-9779
Mailing Address - Country:US
Mailing Address - Phone:989-427-5551
Mailing Address - Fax:989-427-3102
Practice Address - Street 1:215 W HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-9779
Practice Address - Country:US
Practice Address - Phone:989-427-5551
Practice Address - Fax:989-427-3102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006849111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E95013OtherBLUE CROSS PROVIDER I.D.
MION39060Medicare ID - Type Unspecified
MI0E95013OtherBLUE CROSS PROVIDER I.D.