MEDICARE: DR. JEREMY JAMES LEE D.C., A.T.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	X011060	NY
2	111N00000X	Chiropractor	3263	SC
3	111N00000X	Chiropractor	006-0001156	VT
4	2255A2300X	Athletic Trainer	060102433	NY

General Provider Information

NPI Number	:	1356332605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY JAMES LEE D.C., A.T.C.

Provider Business Mailing Address
First Line	:	72 NORTH ST
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1117
Country	:	US
Telephone Number	:	585-447-2775
Fax Number	:	585-286-3100

Provider Business Practice Location Address
First Line	:	131 MAIN ST
Second Line	:
City	:	GENESEO
State	:	NY
Zip	:	14454-1242
Country	:	US
Telephone Number	:	585-447-2775
Fax Number	:	585-286-3100

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/28/2010

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