Provider Demographics
NPI:1811186687
Name:LEE, CHANG YEOL (DC DACRB CSCS FIAMA)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:YEOL
Last Name:LEE
Suffix:
Gender:M
Credentials:DC DACRB CSCS FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WALNUT ST STE 139
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5584
Mailing Address - Country:US
Mailing Address - Phone:972-907-8500
Mailing Address - Fax:972-907-8502
Practice Address - Street 1:445 WALNUT ST STE 139
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5584
Practice Address - Country:US
Practice Address - Phone:972-907-8500
Practice Address - Fax:972-907-8502
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor