Provider Demographics
NPI:1639221278
Name:LEE, HAESUK (DC, LAC)
Entity Type:Individual
Prefix:
First Name:HAESUK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 E OGDEN AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4803
Mailing Address - Country:US
Mailing Address - Phone:630-355-4108
Mailing Address - Fax:630-355-4109
Practice Address - Street 1:1283 E OGDEN AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4803
Practice Address - Country:US
Practice Address - Phone:630-355-4108
Practice Address - Fax:630-355-4109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2954001Medicare PIN