Provider Demographics
NPI:1275756181
Name:LIGON, LEE WILSON (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:WILSON
Last Name:LIGON
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 1:990 S STATE HIGHWAY 5
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-9461
Mailing Address - Country:US
Mailing Address - Phone:214-544-0123
Mailing Address - Fax:
Practice Address - Street 1:990 S STATE HIGHWAY 5
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-9461
Practice Address - Country:US
Practice Address - Phone:214-544-0123
Practice Address - Fax:214-544-0128
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87090FMedicare ID - Type Unspecified
TXU65807Medicare UPIN