Provider Demographics
NPI:1083791065
Name:LEE, SUE O (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:O
Last Name:LEE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29121 N WEST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-3058
Mailing Address - Country:US
Mailing Address - Phone:818-751-9933
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BLVD STE 284
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3509
Practice Address - Country:US
Practice Address - Phone:818-751-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008478111N00000X
CA18665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor