Provider Demographics
NPI:1194821116
Name:LEE, DARREN K (DC)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:K
Last Name:LEE
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 1:400 S MOUNT OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3226
Mailing Address - Country:US
Mailing Address - Phone:479-549-4409
Mailing Address - Fax:479-549-4409
Practice Address - Street 1:400 S MOUNT OLIVE ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3226
Practice Address - Country:US
Practice Address - Phone:479-549-4409
Practice Address - Fax:479-549-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T567Medicare ID - Type Unspecified