MEDICARE: DR. LEE HOLMBERG 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	3502	OK

General Provider Information

NPI Number	:	1841350493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE HOLMBERG D.C

Provider Business Mailing Address
First Line	:	120 N ROBINSON AVE
Second Line	:	SUITE 160 W
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-7502
Country	:	US
Telephone Number	:	405-232-1332
Fax Number	:	405-232-5799

Provider Business Practice Location Address
First Line	:	120 N ROBINSON AVE
Second Line	:	SUITE 160 W
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-7502
Country	:	US
Telephone Number	:	405-232-1332
Fax Number	:	405-232-5799

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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