MEDICARE: BENJAMIN LEE BOSTON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2446	TN

General Provider Information

NPI Number	:	1295056422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN LEE BOSTON D.C.

Provider Business Mailing Address
First Line	:	5099 OLD SUMMER RD # C
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4404
Country	:	US
Telephone Number	:	901-319-2382
Fax Number	:

Provider Business Practice Location Address
First Line	:	5099 OLD SUMMER RD # C
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-4404
Country	:	US
Telephone Number	:	901-319-2382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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