Provider Demographics
NPI:1336845791
Name:PINKHAM, LEE TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:TAYLOR
Last Name:PINKHAM
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 1:2100 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-7285
Mailing Address - Country:US
Mailing Address - Phone:252-945-7456
Mailing Address - Fax:
Practice Address - Street 1:6622 WILLOW PARK DR STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-9016
Practice Address - Country:US
Practice Address - Phone:239-745-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14405111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician