Provider Demographics
NPI:1043842404
Name:LEE, SHANE- ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:SHANE- ANTHONY
Middle Name:
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 1:1389 HUFFMAN PARK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3534
Mailing Address - Country:US
Mailing Address - Phone:907-222-6122
Mailing Address - Fax:907-205-5740
Practice Address - Street 1:750 W DIMOND BLVD STE 121
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1515
Practice Address - Country:US
Practice Address - Phone:907-344-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK155530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor