Provider Demographics
NPI:1881837391
Name:LEE CHIROPRACTIC & ATHLETIC TRAINING PLLC
Entity Type:Organization
Organization Name:LEE CHIROPRACTIC & ATHLETIC TRAINING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:585-447-2775
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1117
Mailing Address - Country:US
Mailing Address - Phone:585-447-2775
Mailing Address - Fax:585-286-3100
Practice Address - Street 1:131 MAIN ST.
Practice Address - Street 2:SUITE 7
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1242
Practice Address - Country:US
Practice Address - Phone:585-447-2775
Practice Address - Fax:585-286-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011060261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA 7452Medicare PIN
NYV05820Medicare UPIN