MEDICARE: LEE CHIROPRACTIC

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	760147220	NY

General Provider Information

NPI Number	:	1215286687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3959 N BUFFALO ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1841
Country	:	US
Telephone Number	:	716-662-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 N BUFFALO ST
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-1841
Country	:	US
Telephone Number	:	716-662-8400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUNA C LEE
Credential	:	DC
Telephone Number	:	607-742-9878

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	08/31/2012

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