Provider Demographics
NPI:1831550300
Name:LEE, SHAKIRA N (DC)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:N
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 1:2305 HACKAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4384
Mailing Address - Country:US
Mailing Address - Phone:770-765-3884
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD STE 635
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8708
Practice Address - Country:US
Practice Address - Phone:770-765-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIRO07597OtherNONE