Provider Demographics
NPI:1578909727
Name:LEE, LAURA M (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1024
Mailing Address - Country:US
Mailing Address - Phone:712-890-9694
Mailing Address - Fax:
Practice Address - Street 1:2281 S 67TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2809
Practice Address - Country:US
Practice Address - Phone:402-570-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007670111N00000X
NE1760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor