MEDICARE: DR. CHENG H 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	9176	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8M6610	OTHER		BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1619964152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHENG H LEE D.C.

Provider Business Mailing Address
First Line	:	11100 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3602
Country	:	US
Telephone Number	:	713-771-2225
Fax Number	:	713-771-1876

Provider Business Practice Location Address
First Line	:	11100 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3602
Country	:	US
Telephone Number	:	713-771-2225
Fax Number	:	713-771-1876

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/23/2015

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