Provider Demographics
NPI:1740617638
Name:LEE, MARSHALL T (DC)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:T
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 1:2821 CROW CANYON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1659
Mailing Address - Country:US
Mailing Address - Phone:925-838-4222
Mailing Address - Fax:925-838-5806
Practice Address - Street 1:2821 CROW CANYON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1659
Practice Address - Country:US
Practice Address - Phone:925-838-4222
Practice Address - Fax:925-838-5806
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor