Provider Demographics
NPI:1386727949
Name:LEE, SHAWN R (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:R
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 1:2105 LAUREL BUSH RD
Mailing Address - Street 2:#103
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6185
Mailing Address - Country:US
Mailing Address - Phone:443-512-0025
Mailing Address - Fax:
Practice Address - Street 1:2105 LAUREL BUSH RD
Practice Address - Street 2:#103
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6185
Practice Address - Country:US
Practice Address - Phone:443-512-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5800OtherHELIX FAMILY CHOICE
MDK739-0001OtherBLUE CHOICE
MD126CSROtherBLUE CROSS
MH681129OtherACN
MDK739-0001OtherBLUE CHOICE
MDV07085Medicare UPIN