MEDICARE: DR. CHOUA LEE 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	4510-012	WI

General Provider Information

NPI Number	:	1518199108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHOUA LEE D.C.

Provider Business Mailing Address
First Line	:	122 S WASHINGTON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4211
Country	:	US
Telephone Number	:	920-435-7575
Fax Number	:	920-435-7574

Provider Business Practice Location Address
First Line	:	122 S WASHINGTON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54301-4211
Country	:	US
Telephone Number	:	920-435-7575
Fax Number	:	920-435-7574

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

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	08/14/2009

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