Provider Demographics
NPI:1083725378
Name:NORMAN, LEE J (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:J
Last Name:NORMAN
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 1:116 EAST AVE N
Mailing Address - Street 2:PO BOX 506
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-1926
Mailing Address - Country:US
Mailing Address - Phone:620-257-3321
Mailing Address - Fax:620-257-3321
Practice Address - Street 1:116 EAST AVE N
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-1926
Practice Address - Country:US
Practice Address - Phone:620-257-3321
Practice Address - Fax:620-257-3321
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005444Medicare ID - Type UnspecifiedCHIROPRACTOR
KS005444Medicare UPIN