Provider Demographics
NPI:1316168255
Name:LEE, PHILIP D (DC LAC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:D
Last Name:LEE
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 S DE ANZA BLVD
Mailing Address - Street 2:#1
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3028
Mailing Address - Country:US
Mailing Address - Phone:408-725-8197
Mailing Address - Fax:408-725-0108
Practice Address - Street 1:10311 S DE ANZA BLVD
Practice Address - Street 2:#1
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3028
Practice Address - Country:US
Practice Address - Phone:408-725-8197
Practice Address - Fax:408-725-0108
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26891111N00000X
CAAC9642171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0268910Medicare ID - Type Unspecified