Provider Demographics
NPI:1548643570
Name:LEE, JOHN S (D C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3019
Mailing Address - Country:US
Mailing Address - Phone:310-784-1328
Mailing Address - Fax:310-784-1328
Practice Address - Street 1:22525 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3019
Practice Address - Country:US
Practice Address - Phone:310-784-1328
Practice Address - Fax:310-784-1328
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor