Provider Demographics
NPI:1104936418
Name:LEE J. KAUFFMAN, DC A CHIROPRACTIC CORP
Entity type:Organization
Organization Name:LEE J. KAUFFMAN, DC A CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JONATHON
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-488-6570
Mailing Address - Street 1:3829 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2646
Mailing Address - Country:US
Mailing Address - Phone:916-488-6570
Mailing Address - Fax:916-488-8466
Practice Address - Street 1:3829 WATT AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2646
Practice Address - Country:US
Practice Address - Phone:916-488-6570
Practice Address - Fax:916-488-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619979523OtherTYPE-1 NPI
CAT04669Medicare ID - Type Unspecified