Provider Demographics
NPI:1992727382
Name:LEE, MARK DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
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 1:1590 CLINGAN RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3650
Mailing Address - Country:US
Mailing Address - Phone:423-473-9700
Mailing Address - Fax:423-473-9707
Practice Address - Street 1:1590 CLINGAN RIDGE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3650
Practice Address - Country:US
Practice Address - Phone:423-473-4850
Practice Address - Fax:423-473-9707
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDC1085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7356920OtherCIGNA HEALTHCARE
TN4073663OtherBLUE CROSS BLUE SHIELD
TN3676954Medicare ID - Type Unspecified
TN4073663OtherBLUE CROSS BLUE SHIELD
TN7356920OtherCIGNA HEALTHCARE