| Wellmate Dr Lee Chiropractic Clinic Inc | |
|
1107 Crenshaw Blvd Los Angeles CA 90019-3112 | |
| (323) 289-8601 | |
| (323) 289-8603 |
| Full Name | Wellmate Dr Lee Chiropractic Clinic Inc |
|---|---|
| Speciality | Chiropractor |
| Location | 1107 Crenshaw Blvd, Los Angeles, California |
| Authorized Official Name and Position | Brian K Lee (PRESIDENT) |
| Authorized Official Contact | 2132108763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellmate Dr Lee Chiropractic Clinic Inc 1107 Crenshaw Blvd Los Angeles CA 90019-3112 Ph: (323) 289-8601 | Wellmate Dr Lee Chiropractic Clinic Inc 1107 Crenshaw Blvd Los Angeles CA 90019-3112 Ph: (323) 289-8601 |
| NPI Number | 1821607268 |
|---|---|
| Provider Enumeration Date | 07/30/2020 |
| Last Update Date | 03/11/2025 |
| Medicare PECOS PAC ID | 2769876143 |
|---|---|
| Medicare Enrollment ID | O20220304001352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821607268 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 111N00000X | Chiropractor | (* (Not Available)) | Primary |
| Provider Name | Jennifer K Champa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144487190 PECOS PAC ID: 9335302140 Enrollment ID: I20120515000134 |
| Provider Name | Brian K Lee |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1295296598 PECOS PAC ID: 6709272560 Enrollment ID: I20220404000295 |
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