Healthcare Provider Details

I. General information

NPI: 1295012185
Provider Name (Legal Business Name): LEE CHIROPRACTIC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 TELEGRAPH RD SUITE 112
PICO RIVERA CA
90660-5500
US

IV. Provider business mailing address

9425 TELEGRAPH RD SUITE 112
PICO RIVERA CA
90660-5500
US

V. Phone/Fax

Practice location:
  • Phone: 949-391-9288
  • Fax:
Mailing address:
  • Phone: 949-391-9288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 31707
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13964
License Number StateCA

VIII. Authorized Official

Name: VICTOR LEE
Title or Position: CEO
Credential: DC, LAC
Phone: 949-391-9288