Provider Demographics
NPI:1689630048
Name:LEE, CHARLES D (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
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 1:7480 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2663
Mailing Address - Country:US
Mailing Address - Phone:937-235-2225
Mailing Address - Fax:937-237-9973
Practice Address - Street 1:7480 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2663
Practice Address - Country:US
Practice Address - Phone:937-235-2225
Practice Address - Fax:937-237-9973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2011852Medicaid
OH2011852Medicaid
OHLE4032281Medicare ID - Type UnspecifiedMEDICARE