Provider Demographics
NPI:1255572848
Name:LEE, RANDI ALYSSA (DC)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:ALYSSA
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 1:4909 GOLDEN TRIANGLE BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4669
Mailing Address - Country:US
Mailing Address - Phone:817-741-8040
Mailing Address - Fax:
Practice Address - Street 1:16990 DALLAS PKWY
Practice Address - Street 2:SUITE #106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1926
Practice Address - Country:US
Practice Address - Phone:972-733-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor