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NPI Code Detail

MEDICARE: DR. DAE SUP LEE D.C.

MEDICARE:  DR. DAE SUP 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
1111N00000XChiropractorDC27623CA

General Provider Information

NPI Number : 1831425495
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAE SUP LEE D.C.
Provider Business Mailing Address
First Line : 19186 WHITE DOVE LN
Second Line :
City : RIVERSIDE
State : CA
Zip : 92508-6034
Country : US
Telephone Number : 714-350-7716
Fax Number : 951-565-8093
Provider Business Practice Location Address
First Line : 25285 MADISON AVE
Second Line : SUITE 108
City : MURRIETA
State : CA
Zip : 92562-8981
Country : US
Telephone Number : 951-600-8198
Fax Number : 951-698-4932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2009
Last Update Date : 01/07/2015

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Directions to “ DR. DAE SUP LEE D.C.” Practice Location

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