Provider Demographics
NPI:1629083159
Name:LEE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:DESJARLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-776-4304
Mailing Address - Street 1:707 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4108
Mailing Address - Country:US
Mailing Address - Phone:919-776-4304
Mailing Address - Fax:919-776-4305
Practice Address - Street 1:707 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4108
Practice Address - Country:US
Practice Address - Phone:919-776-4304
Practice Address - Fax:919-776-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty