=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043462955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN K LEE D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2008
-----------------------------------------------------
Last Update Date | 08/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20657 GOLDEN SPRINGS DRIVE SUITE 202
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-3860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-595-0011
-----------------------------------------------------
Fax | 909-595-0212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 556 W VALLEY BLVD
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-2249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-423-0357
-----------------------------------------------------
Fax | 909-423-0510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC19892
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------