Provider Demographics
NPI:1619979523
Name:KAUFFMAN, LEE JONATHON (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:JONATHON
Last Name:KAUFFMAN
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 1:3829 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2646
Mailing Address - Country:US
Mailing Address - Phone:916-488-6570
Mailing Address - Fax:916-488-8466
Practice Address - Street 1:3829 WATT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2646
Practice Address - Country:US
Practice Address - Phone:916-488-6570
Practice Address - Fax:916-488-8466
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0121990Medicare ID - Type Unspecified