Provider Demographics
NPI:1356647556
Name:LEE, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ROCKINGHAM RD
Mailing Address - Street 2:UNIT 10
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1347
Mailing Address - Country:US
Mailing Address - Phone:973-800-4228
Mailing Address - Fax:
Practice Address - Street 1:60 ROCKINGHAM RD
Practice Address - Street 2:UNIT 10
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1347
Practice Address - Country:US
Practice Address - Phone:973-800-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00698500111N00000X
NH942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor