Individual provider Active NPI

Jennifer Mary Lee, D.C.

  • Rehabilitation Chiropractor
  • Fairfax, VA
National Provider Identifier
1821205352
Registry record updated May 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
0104555856 Issued in VA
Practice address
10301 Democracy LN Ste 110
Fairfax, VA 22030-2545
Phone
(703) 293-2939
Fax
(703) 293-2954
NPI assigned
May 16, 2007
Last updated
May 10, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X 0104555856 VA Primary

Addresses

Primary practice location

10301 Democracy LN Ste 110
Fairfax, VA 22030-2545

Mailing address

10301 Democracy LN
Suite 110
Fairfax, VA 22030-2545
Phone (703) 293-2939

Other identifiers 1

IdentifierTypeStateIssuer
1897636OtherVAFIRST HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190211001658 DC Practitioner - Chiropractic 1052659471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10301 Democracy LN
Suite 110
Fairfax, VA 22030-2545
Phone (703) 293-2939

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0104555856VAMDRehabilitation Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Jennifer M. Lee, LTD CurrentSince Nov 4, 2018 Accepting new patients
Clifford Fruithandler DC PA Past Accepting new patients
Progressive Medical Center PastSince Nov 17, 2006 Accepting new patients

Locations

10301 Democracy Ln
Ste 110
Fairfax, VA 22030
Phone (703) 293-2939

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1821205352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 DEMOCRACY LN",
            "address_2": "SUITE 110",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302545",
            "telephone_number": "703-293-2939",
            "fax_number": "703-293-2954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 DEMOCRACY LN STE 110",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302545",
            "telephone_number": "703-293-2939",
            "fax_number": "703-293-2954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JENNIFER",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "VA",
            "license": "0104555856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1897636",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.