Provider Demographics
NPI:1528145166
Name:LEE, BRUCE D (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
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 1:3200 W 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5477
Mailing Address - Country:US
Mailing Address - Phone:303-429-2012
Mailing Address - Fax:303-429-1090
Practice Address - Street 1:3200 W 72ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5477
Practice Address - Country:US
Practice Address - Phone:303-429-2012
Practice Address - Fax:303-429-1090
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLELB5225OtherBLUE CROSS BLUE SHIELD
COLELB5225OtherBLUE CROSS BLUE SHIELD