Provider Demographics
NPI:1689795429
Name:THOMAS, LEE MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:MICHAEL
Last Name:THOMAS
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 1:10198 NEEDLE PINE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0714
Mailing Address - Country:US
Mailing Address - Phone:303-918-1431
Mailing Address - Fax:
Practice Address - Street 1:5180 PARK AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3521
Practice Address - Country:US
Practice Address - Phone:303-918-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2354OtherTENNESSEE STATE
COCO 5549OtherSTATE LICENSE NUMBER
TN2354OtherTENNESSEE STATE