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General NPI Number Information
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NPI Number | 1063810745
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Entity Type | Organization
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Legal Business Name | KORUS MEDICAL GROUP OF LEE CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 3055 WILSHIRE BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90010-1119
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Country | US
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Telephone | 213-383-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 3055 WILSHIRE BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90010-1119
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Country | US
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Telephone | 213-383-0008
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Fax |
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Authorized Official
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Title or Position | D.C./DIRECTOR
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Name | NELSON LEE
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Credential |
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Telephone | 213-383-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC7286
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC29495
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License Number State | CA
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