Provider Demographics
NPI:1902845225
Name:LEE, KENNETH W (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
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 1:1475 E OAKTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2166
Mailing Address - Country:US
Mailing Address - Phone:847-390-1112
Mailing Address - Fax:847-390-1113
Practice Address - Street 1:1475 E OAKTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2166
Practice Address - Country:US
Practice Address - Phone:847-390-1112
Practice Address - Fax:847-390-1113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU78950Medicare UPIN
IL571150Medicare ID - Type Unspecified