MEDICARE: DR. JEFFREY KENNETH LEE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301006849	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0E95013	OTHER	MI	BLUE CROSS PROVIDER I.D.

General Provider Information

NPI Number	:	1023042678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY KENNETH LEE D.C.

Provider Business Mailing Address
First Line	:	215 W HOWARD CITY EDMORE RD
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-9779
Country	:	US
Telephone Number	:	989-427-5551
Fax Number	:	989-427-3102

Provider Business Practice Location Address
First Line	:	215 W HOWARD CITY EDMORE RD
Second Line	:
City	:	EDMORE
State	:	MI
Zip	:	48829-9779
Country	:	US
Telephone Number	:	989-427-5551
Fax Number	:	989-427-3102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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