Provider Demographics
NPI:1811169295
Name:LEE CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:LEE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:414-431-7101
Mailing Address - Street 1:6524 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2038
Mailing Address - Country:US
Mailing Address - Phone:414-431-7101
Mailing Address - Fax:414-431-7102
Practice Address - Street 1:6524 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2038
Practice Address - Country:US
Practice Address - Phone:414-431-7101
Practice Address - Fax:414-431-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3882-012261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497813364OtherPERSONAL NPI NUMBER
WI38942400Medicaid
WI1497813364OtherPERSONAL NPI NUMBER
WI75155Medicare PIN