Provider Demographics
NPI:1063214195
Name:THEODORE-LEE, AERMON J (DC)
Entity type:Individual
Prefix:
First Name:AERMON
Middle Name:J
Last Name:THEODORE-LEE
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13925 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5118
Mailing Address - Country:US
Mailing Address - Phone:361-767-3300
Mailing Address - Fax:361-767-3320
Practice Address - Street 1:13925 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5118
Practice Address - Country:US
Practice Address - Phone:361-767-3300
Practice Address - Fax:361-767-3320
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor