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General NPI Number Information
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NPI Number | 1124405444
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Entity Type | Organization
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Legal Business Name | DAE S. LEE, D.C. INC., A CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 25285 MADISON AVE SUITE 108
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City | MURRIETA
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State | CA
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Zip | 92562-8981
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Country | US
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Telephone | 951-600-8198
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Fax | 951-698-4932
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Provider Business Mailing Address
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Address Line | 25285 MADISON AVE SUITE 108
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City | MURRIETA
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State | CA
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Zip | 92562-8981
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Country | US
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Telephone | 951-600-8198
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Fax | 951-698-4932
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Authorized Official
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Title or Position | OWNER
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Name | DAE SUP LEE
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Credential | D.C.
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Telephone | 951-600-8198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC27623
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License Number State | CA
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