Healthcare Provider Details

I. General information

NPI: 1043286149
Provider Name (Legal Business Name): LEE BRENT DOVER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 US HIGHWAY 90 E SUITE 107
CASTROVILLE TX
78009-5246
US

IV. Provider business mailing address

711 MIDWAY CRST
SAN ANTONIO TX
78258-4335
US

V. Phone/Fax

Practice location:
  • Phone: 830-931-2211
  • Fax: 830-538-3778
Mailing address:
  • Phone: 501-337-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1507
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: