=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740433556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL LEE DC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2008
-----------------------------------------------------
Last Update Date | 10/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5203 CHIPPEWA ST STE 200
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63109-2356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-832-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5203 CHIPPEWA ST STE 200
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63109-2356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-832-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL H LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-832-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 006404
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------