Provider Demographics
NPI:1154455301
Name:LEE, AMY LAURA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LAURA
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 AQUILA DR N STE 825
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3798
Mailing Address - Country:US
Mailing Address - Phone:763-323-3456
Mailing Address - Fax:
Practice Address - Street 1:11350 AQUILA DR N STE 825
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3798
Practice Address - Country:US
Practice Address - Phone:763-323-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor