Provider Demographics
NPI:1427372010
Name:JY LEE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:JY LEE CHIROPRACTIC LLC
Other - Org Name:JY LEE CHIROPRACTIC & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN YUP
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-956-1003
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00677700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty