Provider Demographics
NPI:1851434765
Name:LEE, TIM J (DC)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:J
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 1:4667 NORTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019
Mailing Address - Country:US
Mailing Address - Phone:502-845-2225
Mailing Address - Fax:502-845-2226
Practice Address - Street 1:4667 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019
Practice Address - Country:US
Practice Address - Phone:502-845-2225
Practice Address - Fax:502-845-2226
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6108201Medicare PIN
262464693OtherEIN