Provider Demographics
NPI:1316903438
Name:LEE, KEVIN R (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:R
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6250 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781
Mailing Address - Country:US
Mailing Address - Phone:727-541-2520
Mailing Address - Fax:727-544-8971
Practice Address - Street 1:6250 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-541-2520
Practice Address - Fax:727-544-8971
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381417300Medicaid
FL381417300Medicaid
FL55566Medicare ID - Type Unspecified