Provider Demographics
NPI:1912474750
Name:LEE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:LEE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:712-389-4528
Mailing Address - Street 1:1512 DAKOTA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-2665
Mailing Address - Country:US
Mailing Address - Phone:402-494-2141
Mailing Address - Fax:
Practice Address - Street 1:1512 DAKOTA AVE STE D
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2665
Practice Address - Country:US
Practice Address - Phone:402-494-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty