Provider Demographics
NPI:1073922936
Name:MARVIN C LEE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MARVIN C LEE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-375-5147
Mailing Address - Street 1:1625 W OLYMPIC BLVD STE M103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3824
Mailing Address - Country:US
Mailing Address - Phone:323-375-5147
Mailing Address - Fax:323-375-5155
Practice Address - Street 1:1625 W OLYMPIC BLVD STE M103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3824
Practice Address - Country:US
Practice Address - Phone:323-375-5147
Practice Address - Fax:323-375-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty