Healthcare Provider Details

I. General information

NPI: 1821607268
Provider Name (Legal Business Name): WELLMATE DR LEE CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 03/11/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

IV. Provider business mailing address

1107 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 323-289-8601
  • Fax: 323-289-8603
Mailing address:
  • Phone: 323-289-8601
  • Fax: 323-289-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN K LEE
Title or Position: PRESIDENT
Credential: DC
Phone: 213-210-8763