Provider Demographics
NPI:1346638731
Name:LEE CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC CENTER INC.
Other - Org Name:LEE CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-390-1112
Mailing Address - Street 1:1430 E THACKER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6460
Mailing Address - Country:US
Mailing Address - Phone:847-390-1112
Mailing Address - Fax:847-390-1113
Practice Address - Street 1:1430 E THACKER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6460
Practice Address - Country:US
Practice Address - Phone:847-390-1112
Practice Address - Fax:847-390-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL571150Medicare UPIN