Provider Demographics
NPI:1396039269
Name:COUSINEAU, LEE ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ALLEN
Last Name:COUSINEAU
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 1:5421 PENINSULA DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9229
Mailing Address - Country:US
Mailing Address - Phone:360-456-6418
Mailing Address - Fax:360-456-6008
Practice Address - Street 1:2625 WILLAMETTE DR NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-1312
Practice Address - Country:US
Practice Address - Phone:360-412-3255
Practice Address - Fax:360-456-6008
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor