Provider Demographics
NPI:1508039355
Name:LEE, MARJORIE MAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:MAY
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARJORIE
Other - Middle Name:MAY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1204 LINCOLN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7436
Mailing Address - Country:US
Mailing Address - Phone:510-769-8535
Mailing Address - Fax:510-865-3403
Practice Address - Street 1:1204 LINCOLN AVE STE B
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7436
Practice Address - Country:US
Practice Address - Phone:510-769-8535
Practice Address - Fax:510-865-3403
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK190AMedicare PIN