Provider Demographics
NPI:1063580447
Name:LEE, MARTIN DAVIS (DC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DAVIS
Last Name:LEE
Suffix:
Gender:M
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:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1072
Mailing Address - Country:US
Mailing Address - Phone:919-894-3600
Mailing Address - Fax:919-894-2535
Practice Address - Street 1:106 SOUTH ELM STREET
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504
Practice Address - Country:US
Practice Address - Phone:919-894-3600
Practice Address - Fax:919-894-2535
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890833LMedicaid
NC890833LMedicaid
NC2452414Medicare ID - Type Unspecified