Provider Demographics
NPI:1578631271
Name:LEE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-927-5913
Mailing Address - Street 1:3667 BAHIA VISTA ST STE A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2407
Mailing Address - Country:US
Mailing Address - Phone:941-927-5913
Mailing Address - Fax:941-927-5914
Practice Address - Street 1:3667 BAHIA VISTA ST STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2407
Practice Address - Country:US
Practice Address - Phone:941-927-5913
Practice Address - Fax:941-927-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280009800Medicaid
FLK3110Medicare PIN