MEDICARE: DR. STEPHANIE MICHELLE LEE DC, LAC

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	171100000X	Acupuncturist	84000211A	IN
2	111N00000X	Chiropractor	08003110A	IN

General Provider Information

NPI Number	:	1649772179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE MICHELLE LEE DC, LAC

Provider Business Mailing Address
First Line	:	3308 W 61ST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-1009
Country	:	US
Telephone Number	:	317-997-3183
Fax Number	:

Provider Business Practice Location Address
First Line	:	3308 W 61ST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-1009
Country	:	US
Telephone Number	:	317-997-3183
Fax Number	:

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

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	11/29/2024

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