Provider Demographics
NPI:1922141209
Name:LEE, PAULA (DC)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2501
Mailing Address - Country:US
Mailing Address - Phone:608-849-4521
Mailing Address - Fax:608-849-8516
Practice Address - Street 1:1024 QUINN DR
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2501
Practice Address - Country:US
Practice Address - Phone:608-849-4521
Practice Address - Fax:608-849-8516
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2647-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU18912Medicare UPIN
WI000135440Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER