Provider Demographics
NPI:1083936470
Name:LEE, JUN YUP (DC)
Entity Type:Individual
Prefix:DR
First Name:JUN YUP
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 1:669 BROAD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1631
Mailing Address - Country:US
Mailing Address - Phone:201-585-1020
Mailing Address - Fax:201-917-3588
Practice Address - Street 1:669 BROAD AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1631
Practice Address - Country:US
Practice Address - Phone:201-585-1020
Practice Address - Fax:201-917-3588
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00677700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor