Provider Demographics
NPI:1033144068
Name:LEE, JAMIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25251 PASEO DE ALICIA
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4616
Mailing Address - Country:US
Mailing Address - Phone:949-583-9116
Mailing Address - Fax:949-859-0230
Practice Address - Street 1:25251 PASEO DE ALICIA
Practice Address - Street 2:SUITE 103
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4616
Practice Address - Country:US
Practice Address - Phone:949-583-9116
Practice Address - Fax:949-859-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18558Medicare UPIN
CADC17516AMedicare ID - Type Unspecified