Provider Demographics
NPI:1225385057
Name:JESSICA LEE CHIROPRACTIC. INC
Entity Type:Organization
Organization Name:JESSICA LEE CHIROPRACTIC. INC
Other - Org Name:MIRAMAR CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-577-0662
Mailing Address - Street 1:7080 MIRAMAR RD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:858-577-0662
Mailing Address - Fax:858-391-6686
Practice Address - Street 1:7080 MIRAMAR RD
Practice Address - Street 2:STE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2333
Practice Address - Country:US
Practice Address - Phone:858-577-0662
Practice Address - Fax:858-391-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty