MEDICARE: PAUL LEE DC PC

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	006404	MO

General Provider Information

NPI Number	:	1740433556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL LEE DC PC

Provider Business Mailing Address
First Line	:	5203 CHIPPEWA ST STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2356
Country	:	US
Telephone Number	:	314-832-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5203 CHIPPEWA ST STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2356
Country	:	US
Telephone Number	:	314-832-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL H LEE
Credential	:
Telephone Number	:	314-832-2200

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	10/24/2008

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