=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447788617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D. H. LEE CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2017
-----------------------------------------------------
Last Update Date | 05/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3510 1/2 OCEAN VIEW BLVD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91208-1285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-839-1336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2446 ORANGE AVE
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91214-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-372-4806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID H LEE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 818-839-1336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------