Provider Demographics
NPI:1710097183
Name:HARRELSON-LEE, ELIZABETH ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HARRELSON-LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875-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 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3033
Practice Address - Country:US
Practice Address - Phone:904-261-1800
Practice Address - Fax:904-261-1830
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55172OtherBLUE CROSS BLUE SHIELD
50813Medicare UPIN
FL55172Medicare ID - Type Unspecified