Provider Demographics
NPI:1215935069
Name:LEMMON, DAVID LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:LEMMON
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 1:318 S 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942
Mailing Address - Country:US
Mailing Address - Phone:509-697-4123
Mailing Address - Fax:509-697-4423
Practice Address - Street 1:318 S 1ST STREET
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942
Practice Address - Country:US
Practice Address - Phone:509-697-4123
Practice Address - Fax:509-697-4423
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2019-03-05
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
WACH00001911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA84043OtherWORKERS COMP
WA0324466OtherL&I
WA1054099Medicaid
WA0324466OtherL&I
WA912150993OtherTAX ID NUMBER
WA000119195Medicare ID - Type Unspecified
WA1054099Medicaid