Provider Demographics
NPI:1942465497
Name:LEE, MICAHEL B (DC)
Entity Type:Individual
Prefix:DR
First Name:MICAHEL
Middle Name:B
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 1:3601 W SWANN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4547
Mailing Address - Country:US
Mailing Address - Phone:813-873-7705
Mailing Address - Fax:813-873-7705
Practice Address - Street 1:3601 W SWANN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4547
Practice Address - Country:US
Practice Address - Phone:813-873-7705
Practice Address - Fax:813-873-7705
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor