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General NPI Number Information
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NPI Number | 1477943843
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Entity Type | Organization
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Legal Business Name | AFFINITY CHIROPRACTIC CARE LLC
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 225 UNIVERSITY AVE W SUITE 121A
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City | SAINT PAUL
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State | MN
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Zip | 55103-2072
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Country | US
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Telephone | 651-894-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 225 UNIVERSITY AVE W SUITE 121A
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City | SAINT PAUL
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State | MN
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Zip | 55103-2072
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Country | US
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Telephone | 651-894-4830
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTIAN ETHAN LEE
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Credential | DC
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Telephone | 651-894-4830
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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 | 5632
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License Number State | MN
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