Healthcare Provider Details

I. General information

NPI: 1760618581
Provider Name (Legal Business Name): DR LEE CHIROPRACTIC & ACUPUNCTURE LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 E OGDEN AVE SUITE 175
NAPERVILLE IL
60563-4803
US

IV. Provider business mailing address

1283 E OGDEN AVE SUITE 175
NAPERVILLE IL
60563-4803
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-4108
  • Fax: 630-355-4109
Mailing address:
  • Phone: 630-355-4108
  • Fax: 630-355-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010871
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198-000759
License Number StateIL

VIII. Authorized Official

Name: SADNA MOHAN
Title or Position: BILLING MANAGER
Credential:
Phone: 630-375-6500