Provider Demographics
NPI:1902811482
Name:LALLIER, LEE S (DC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:S
Last Name:LALLIER
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 1:722 GROSS RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3204
Mailing Address - Country:US
Mailing Address - Phone:972-285-7000
Mailing Address - Fax:972-285-9903
Practice Address - Street 1:722 GROSS RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3204
Practice Address - Country:US
Practice Address - Phone:972-285-7000
Practice Address - Fax:972-285-9903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU00918Medicare UPIN
TX603899Medicare ID - Type Unspecified