Provider Demographics
NPI:1710162037
Name:LEE, JOSEPHINE YICKFONG (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:YICKFONG
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7881
Mailing Address - Country:US
Mailing Address - Phone:636-386-3333
Mailing Address - Fax:636-527-2570
Practice Address - Street 1:14805 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7881
Practice Address - Country:US
Practice Address - Phone:636-386-3333
Practice Address - Fax:636-527-2570
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008741111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition