Provider Demographics
NPI:1275724445
Name:NGUYEN, LEE T (DC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:T
Last Name:NGUYEN
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 1:12761 FREDERICK ST
Mailing Address - Street 2:#307
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4524
Mailing Address - Country:US
Mailing Address - Phone:626-429-9669
Mailing Address - Fax:
Practice Address - Street 1:1450 W 6TH ST
Practice Address - Street 2:102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3060
Practice Address - Country:US
Practice Address - Phone:951-372-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30622111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health