Provider Demographics
NPI:1467467167
Name:LEE CHIROPRACTIC & ANGEL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC & ANGEL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOONYOUNG
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-933-8814
Mailing Address - Street 1:937 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1938
Mailing Address - Country:US
Mailing Address - Phone:323-933-8814
Mailing Address - Fax:323-933-8815
Practice Address - Street 1:937 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1938
Practice Address - Country:US
Practice Address - Phone:323-933-8814
Practice Address - Fax:323-933-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25158111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25158AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER