Provider Demographics
NPI:1740381482
Name:LEE CHIROPRACTIC & REHAB WELLNESS CENTER
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC & REHAB WELLNESS CENTER
Other - Org Name:PACIFIC CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-502-8999
Mailing Address - Street 1:PO BOX 661455
Mailing Address - Street 2:
Mailing Address - City:L.A.
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:310-502-8999
Mailing Address - Fax:310-458-0088
Practice Address - Street 1:1247 7TH ST.
Practice Address - Street 2:#300
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401
Practice Address - Country:US
Practice Address - Phone:310-452-9146
Practice Address - Fax:310-452-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91481Medicare UPIN
CAWDC26294AMedicare ID - Type Unspecified
CAW18645Medicare ID - Type Unspecified