Provider Demographics
NPI:1528062114
Name:LEE, JUDSON S (DC)
Entity type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:S
Last Name:LEE
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 1:101 N 1ST AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1902
Mailing Address - Country:US
Mailing Address - Phone:623-374-2516
Mailing Address - Fax:480-275-3464
Practice Address - Street 1:101 N 1ST AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1902
Practice Address - Country:US
Practice Address - Phone:623-374-2516
Practice Address - Fax:480-275-3464
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-03-31
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
MECR1836111N00000X
AZ8075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor