Provider Demographics
NPI:1922069814
Name:WEINSTEIN, LEE GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:GREGORY
Last Name:WEINSTEIN
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 1:115 E TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1019
Mailing Address - Country:US
Mailing Address - Phone:610-789-1800
Mailing Address - Fax:610-789-2627
Practice Address - Street 1:115 E TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1019
Practice Address - Country:US
Practice Address - Phone:610-789-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU89491Medicare UPIN
PA056818Medicare PIN