Provider Demographics
NPI:1558487801
Name:LEE CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-275-3020
Mailing Address - Street 1:1831 BROWN BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4600
Mailing Address - Country:US
Mailing Address - Phone:817-275-3020
Mailing Address - Fax:817-275-6128
Practice Address - Street 1:1831 BROWN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-4600
Practice Address - Country:US
Practice Address - Phone:817-275-3020
Practice Address - Fax:817-275-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00057SOtherMEDICARE GROUP NUMBER
TX8A6255OtherBCBS NUMBER
TX83346EMedicare ID - Type UnspecifiedMEDICARE NUMBER
TX8A6255OtherBCBS NUMBER