Provider Demographics
NPI:1851495287
Name:LEE, BOB H (DC)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:H
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 1:18102 SKY PARK CIR
Mailing Address - Street 2:SUITE E
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6531
Mailing Address - Country:US
Mailing Address - Phone:949-861-8121
Mailing Address - Fax:949-861-8124
Practice Address - Street 1:18102 SKY PARK CIR
Practice Address - Street 2:SUITE E
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6531
Practice Address - Country:US
Practice Address - Phone:949-861-8121
Practice Address - Fax:949-861-8124
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV03276Medicare UPIN