Provider Demographics
NPI:1902825193
Name:CHRISTOPHER G LEE DC DBA LIFELINE CHIROPRACTIC
Entity Type:Organization
Organization Name:CHRISTOPHER G LEE DC DBA LIFELINE CHIROPRACTIC
Other - Org Name:MASONTOWN CHIROPRATIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-583-9777
Mailing Address - Street 1:7 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15461-1809
Mailing Address - Country:US
Mailing Address - Phone:724-583-9777
Mailing Address - Fax:724-583-9777
Practice Address - Street 1:7 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-1809
Practice Address - Country:US
Practice Address - Phone:724-583-9777
Practice Address - Fax:724-583-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC5007L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1834848OtherBLUES
PA=========OtherCOMMERCIAL