Provider Demographics
NPI:1922468982
Name:LEE, CHONG IL (DC)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:IL
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:11734 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5026
Mailing Address - Country:US
Mailing Address - Phone:206-364-9501
Mailing Address - Fax:
Practice Address - Street 1:11734 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5026
Practice Address - Country:US
Practice Address - Phone:206-364-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33498111N00000X
WACH60757172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33498OtherCHIROPRACTIC
WACH60757172OtherCHIROPRACTIC