Provider Demographics
NPI:1275019317
Name:STAFFORD, LEE TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:TYLER
Last Name:STAFFORD
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 1:931B S MAIN ST STE 145
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7439
Mailing Address - Country:US
Mailing Address - Phone:336-870-2522
Mailing Address - Fax:
Practice Address - Street 1:5006 HIGH POINT RD STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6235
Practice Address - Country:US
Practice Address - Phone:336-870-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor