Provider Demographics
NPI:1124030101
Name:NAGEL, LEE JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:JOSEPH
Last Name:NAGEL
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:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IN
Mailing Address - Zip Code:46793-0477
Mailing Address - Country:US
Mailing Address - Phone:260-837-6331
Mailing Address - Fax:260-837-7938
Practice Address - Street 1:3386 CO. RD. 427
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IN
Practice Address - Zip Code:46793
Practice Address - Country:US
Practice Address - Phone:260-837-6331
Practice Address - Fax:260-837-7938
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002021A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN198590AMedicare ID - Type Unspecified
INU89650Medicare UPIN