Provider Demographics
NPI:1710189774
Name:LEE, JONG IL (DC)
Entity Type:Individual
Prefix:
First Name:JONG IL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:16030 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1741
Mailing Address - Country:US
Mailing Address - Phone:425-582-1022
Mailing Address - Fax:425-385-2230
Practice Address - Street 1:16030 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1741
Practice Address - Country:US
Practice Address - Phone:425-582-1022
Practice Address - Fax:425-385-2230
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2009-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WACH00034764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor