Provider Demographics
NPI:1376853416
Name:LEE, SEOK JOON (DC)
Entity Type:Individual
Prefix:DR
First Name:SEOK JOON
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 1:3545 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2388
Mailing Address - Country:US
Mailing Address - Phone:800-355-9689
Mailing Address - Fax:800-993-7780
Practice Address - Street 1:3545 WILSHIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2388
Practice Address - Country:US
Practice Address - Phone:800-355-9689
Practice Address - Fax:800-993-7780
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25589111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition