Provider Demographics
NPI:1821205352
Name:LEE, JENNIFER MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10301 DEMOCRACY LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2545
Mailing Address - Country:US
Mailing Address - Phone:703-293-2939
Mailing Address - Fax:703-293-2954
Practice Address - Street 1:10301 DEMOCRACY LN STE 110
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2545
Practice Address - Country:US
Practice Address - Phone:703-293-2939
Practice Address - Fax:703-293-2954
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555856111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1897636OtherFIRST HEALTH
VA1897636OtherFIRST HEALTH