MEDICARE: LEE CHIROPRACTIC & ATHLETIC TRAINING PLLC

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	261QM2500X	Medical Specialty Clinic/Center	X011060	NY

General Provider Information

NPI Number	:	1881837391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE CHIROPRACTIC & ATHLETIC TRAINING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 605
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	:	SUITE 7
City	:	GENESEO
State	:	NY
Zip	:	14454-1242
Country	:	US
Telephone Number	:	585-447-2775
Fax Number	:	585-286-3100

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEREMY JAMES LEE
Credential	:	DC, ATC
Telephone Number	:	585-447-2775

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	11/08/2012

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