Provider Demographics
NPI:1689755589
Name:LEE CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HARRELSON-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-261-1800
Mailing Address - Street 1:1875-A S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3033
Mailing Address - Country:US
Mailing Address - Phone:904-261-1800
Mailing Address - Fax:904-261-1830
Practice Address - Street 1:1875-A SOUTH 14TH STREET
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-261-1800
Practice Address - Fax:904-261-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty