=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962662163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONG G LEE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2008
-----------------------------------------------------
Last Update Date | 06/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4590 RIVERSIDE DR SUITE A
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-3980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-591-1010
-----------------------------------------------------
Fax | 909-591-6767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4590 RIVERSIDE DR SUITE A
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-3980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-591-1010
-----------------------------------------------------
Fax | 909-591-6767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 24738
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------