Provider Demographics
NPI:1427057520
Name:LEE, GREGORY ALLEN (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
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 1:1408 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1126
Mailing Address - Country:US
Mailing Address - Phone:320-843-4424
Mailing Address - Fax:320-843-4229
Practice Address - Street 1:1408 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-1126
Practice Address - Country:US
Practice Address - Phone:320-843-4424
Practice Address - Fax:320-843-4229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN230470OtherCHIROCARE
MN1D406LEOtherBLUE CROSS/BLUE SHIELD
MN0693OtherHEALTH SERVICES MANAGEMNT
MN45429LEOtherBLUE CROSS/BLUE SHIELD
T65775Medicare UPIN