Provider Demographics
NPI:1164628095
Name:PHELPS, LEE MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:MARK
Last Name:PHELPS
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 1:7815 GREENWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4633
Mailing Address - Country:US
Mailing Address - Phone:206-789-5704
Mailing Address - Fax:206-782-6432
Practice Address - Street 1:7815 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4633
Practice Address - Country:US
Practice Address - Phone:206-789-5704
Practice Address - Fax:206-782-6432
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2096105Medicaid
WA2096105Medicaid
WAPH2207Medicare UPIN