Provider Demographics
NPI:1417096264
Name:LEE, JEFFREY C (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:LEE
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 1:100 SKYLINE PLZ STE 103
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3820
Mailing Address - Country:US
Mailing Address - Phone:650-991-2882
Mailing Address - Fax:650-991-3338
Practice Address - Street 1:100 SKYLINE PLZ STE 103
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3820
Practice Address - Country:US
Practice Address - Phone:650-991-2882
Practice Address - Fax:650-991-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor