Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | CH5057 | FL |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | X004425-1 | NY |
NPI | 1578629093 |
---|---|
Provider Name | Dr. Lee Craig Vandusen |
First Address | Seneca Falls, NY 13148-8720 |
Second Address | Seneca Falls, NY 13148-8720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |