Provider Demographics
NPI:1760635569
Name:LEE, TENNY JAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TENNY
Middle Name:JAN
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 1:2381 GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-7042
Mailing Address - Country:US
Mailing Address - Phone:510-886-3345
Mailing Address - Fax:510-886-3315
Practice Address - Street 1:2381 GROVE WAY
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-7042
Practice Address - Country:US
Practice Address - Phone:510-886-3345
Practice Address - Fax:510-886-3315
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23546111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation