Provider Demographics
NPI:1265745608
Name:LEE, JERRY (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MONTEREY PASS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2437
Mailing Address - Country:US
Mailing Address - Phone:626-551-5155
Mailing Address - Fax:626-551-5156
Practice Address - Street 1:670 MONTEREY PASS RD STE 100
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-2437
Practice Address - Country:US
Practice Address - Phone:626-551-5155
Practice Address - Fax:626-551-5156
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31006111N00000X
CAAC13516171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist