Provider Demographics
NPI:1043857915
Name:LEE, CHANGWON (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANGWON
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 1:1606 GOLDEN ASPEN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8011
Mailing Address - Country:US
Mailing Address - Phone:515-233-8880
Mailing Address - Fax:
Practice Address - Street 1:1606 GOLDEN ASPEN DR STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8011
Practice Address - Country:US
Practice Address - Phone:515-233-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor