MEDICARE: DR. MARVIN C. 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	DC 26294	CA

General Provider Information

NPI Number	:	1477566438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN C. LEE D.C.

Provider Business Mailing Address
First Line	:	1625 W OLYMPIC BLVD
Second Line	:	SUITE M103
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3809
Country	:	US
Telephone Number	:	323-375-5147
Fax Number	:	323-375-5155

Provider Business Practice Location Address
First Line	:	1625 W OLYMPIC BLVD
Second Line	:	SUITE M103
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3809
Country	:	US
Telephone Number	:	323-375-5147
Fax Number	:	323-375-5155

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/06/2014

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