Provider Demographics
NPI:1659373694
Name:LEE, ERIC ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALLEN
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 1:2407 E SUSSEX WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4035
Mailing Address - Country:US
Mailing Address - Phone:559-227-8437
Mailing Address - Fax:559-227-8439
Practice Address - Street 1:2407 E SUSSEX WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4035
Practice Address - Country:US
Practice Address - Phone:559-227-8437
Practice Address - Fax:559-227-8439
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-09-30
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CA20286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0202860Medicare PIN