Provider Demographics
NPI:1740568740
Name:LEE, SCOTT S (LAC, DOM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2605
Mailing Address - Country:US
Mailing Address - Phone:847-808-7575
Mailing Address - Fax:
Practice Address - Street 1:737 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2605
Practice Address - Country:US
Practice Address - Phone:847-808-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist