Provider Demographics
NPI:1790843936
Name:SMITH, LEE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:JOSEPH
Last Name:SMITH
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 1:2728 ASBURY RD
Mailing Address - Street 2:STE. 920
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2971
Mailing Address - Country:US
Mailing Address - Phone:563-582-5185
Mailing Address - Fax:563-582-3075
Practice Address - Street 1:2728 ASBURY RD
Practice Address - Street 2:STE. 920
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2971
Practice Address - Country:US
Practice Address - Phone:563-582-5185
Practice Address - Fax:563-582-3075
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37388OtherBLUE CROSS BLUE SHEILD
IA1254623Medicaid
IA1254623Medicaid
IA37388OtherBLUE CROSS BLUE SHEILD