Provider Demographics
NPI:1871858381
Name:LEE, DONG CHANG (DC)
Entity Type:Individual
Prefix:
First Name:DONG CHANG
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 1:404 E BANNISTER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3092
Mailing Address - Country:US
Mailing Address - Phone:816-444-1218
Mailing Address - Fax:866-291-2490
Practice Address - Street 1:404 E BANNISTER RD
Practice Address - Street 2:SUITE B
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3092
Practice Address - Country:US
Practice Address - Phone:816-444-1218
Practice Address - Fax:866-291-2490
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016839111N00000X
KS01-05485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor