Provider Demographics
NPI:1639188790
Name:LEE, TAEHO (DC)
Entity Type:Individual
Prefix:
First Name:TAEHO
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 1:1000 TEXAN TRL STE 120
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3774
Mailing Address - Country:US
Mailing Address - Phone:817-552-7246
Mailing Address - Fax:817-329-6950
Practice Address - Street 1:1000 TEXAN TRL STE 120
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3774
Practice Address - Country:US
Practice Address - Phone:817-552-7246
Practice Address - Fax:817-329-6950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202511138OtherGROUP ORGANIZATIONS TYPE