Provider Demographics
NPI:1043696297
Name:LEE, JIBOK (DC)
Entity Type:Individual
Prefix:
First Name:JIBOK
Middle Name:
Last Name:LEE
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 1:2530 NE KRESKY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2406
Mailing Address - Country:US
Mailing Address - Phone:360-996-4800
Mailing Address - Fax:
Practice Address - Street 1:2530 NE KRESKY AVE
Practice Address - Street 2:STE A
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2406
Practice Address - Country:US
Practice Address - Phone:360-996-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60576300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor