Provider Demographics
NPI:1275223760
Name:LEE SANG, JEFFREY AUGUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:AUGUSTIN
Last Name:LEE SANG
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 1:750 SCHNEIDER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3360
Mailing Address - Country:US
Mailing Address - Phone:210-566-7873
Mailing Address - Fax:210-566-8799
Practice Address - Street 1:750 SCHNEIDER DR STE 170
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3360
Practice Address - Country:US
Practice Address - Phone:210-566-7873
Practice Address - Fax:210-566-8799
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor