Provider Demographics
NPI:1548405657
Name:LEE, RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
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 1:1080 BLOSSOM HILL RD
Mailing Address - Street 2:G
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1106
Mailing Address - Country:US
Mailing Address - Phone:408-723-0125
Mailing Address - Fax:
Practice Address - Street 1:1080 BLOSSOM HILL RD
Practice Address - Street 2:G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1106
Practice Address - Country:US
Practice Address - Phone:408-723-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor