Individual
MR. KEVIN ROBERT LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
128 W WALLED LAKE DR, WALLED LAKE, MI 48390-3455
(248) 926-1829
(248) 926-1837
Mailing address
128 W WALLED LAKE DR, WALLED LAKE, MI 48390-3455
(248) 926-1829
(248) 926-1837
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
KL007525
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950F354240
BLUE CROSS/BLUE SHIELD
MI
01
—
KL007525
COMMERCIAL
MI
Enumeration date
06/13/2006
Last updated
02/03/2022
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