Provider Demographics
NPI:1194859728
Name:SHAWN R LEE DC LLC
Entity Type:Organization
Organization Name:SHAWN R LEE DC LLC
Other - Org Name:SUSQUEHANNA SPINE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-512-0025
Mailing Address - Street 1:2105 LAUREL BUSH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6185
Mailing Address - Country:US
Mailing Address - Phone:443-512-0025
Mailing Address - Fax:
Practice Address - Street 1:2105 LAUREL BUSH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6185
Practice Address - Country:US
Practice Address - Phone:443-512-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134PMedicare ID - Type UnspecifiedMEDICARE
MDY43969Medicare UPIN