MEDICARE: CHRISTOPHER G LEE DC DBA LIFELINE CHIROPRACTIC

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	DC5007L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1834848	OTHER	PA	BLUES

General Provider Information

NPI Number	:	1902825193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER G LEE DC DBA LIFELINE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7 N WASHINGTON ST
Second Line	:
City	:	MASONTOWN
State	:	PA
Zip	:	15461-1809
Country	:	US
Telephone Number	:	724-583-9777
Fax Number	:	724-583-9777

Provider Business Practice Location Address
First Line	:	7 N WASHINGTON ST
Second Line	:
City	:	MASONTOWN
State	:	PA
Zip	:	15461-1809
Country	:	US
Telephone Number	:	724-583-9777
Fax Number	:	724-583-9777

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER G LEE
Credential	:	DC
Telephone Number	:	724-583-9777

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2008

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