Provider Demographics
NPI:1639283880
Name:DR LEE NAGEL PC
Entity Type:Organization
Organization Name:DR LEE NAGEL PC
Other - Org Name:DEKALB CHIROPRACTIC CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-837-6331
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IN
Mailing Address - Zip Code:46793-0477
Mailing Address - Country:US
Mailing Address - Phone:260-837-6331
Mailing Address - Fax:260-837-7938
Practice Address - Street 1:3386 CO. RD. 427
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IN
Practice Address - Zip Code:46793
Practice Address - Country:US
Practice Address - Phone:260-837-6331
Practice Address - Fax:260-837-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002021A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN198590Medicare ID - Type Unspecified