Provider Demographics
NPI:1487861225
Name:CARPENTER, LEE CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:CHARLES
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:CHARLES
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1822 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5270
Mailing Address - Country:US
Mailing Address - Phone:602-274-3516
Mailing Address - Fax:
Practice Address - Street 1:1822 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5270
Practice Address - Country:US
Practice Address - Phone:602-274-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor