Provider Demographics
NPI:1104923515
Name:LEE, ROGER (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
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 1:14795 JEFFREY RD
Mailing Address - Street 2:SITE 103
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0414
Mailing Address - Country:US
Mailing Address - Phone:949-857-8883
Mailing Address - Fax:949-857-0270
Practice Address - Street 1:14795 JEFFREY RD
Practice Address - Street 2:SITE 103
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0414
Practice Address - Country:US
Practice Address - Phone:949-857-8883
Practice Address - Fax:949-857-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC26091AMedicare ID - Type Unspecified