Provider Demographics
NPI:1598772410
Name:LEE, JASON LAP (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LAP
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 1:515 SANITARIUM RD
Mailing Address - Street 2:
Mailing Address - City:ST HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574
Mailing Address - Country:US
Mailing Address - Phone:707-963-1001
Mailing Address - Fax:707-963-4194
Practice Address - Street 1:515 SANITARIUM RD
Practice Address - Street 2:
Practice Address - City:ST HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574
Practice Address - Country:US
Practice Address - Phone:707-963-1001
Practice Address - Fax:707-963-4194
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0260900Medicare ID - Type Unspecified