Provider Demographics
NPI:1023502366
Name:LEE-JUNG, REINA SUL (DC)
Entity type:Individual
Prefix:
First Name:REINA
Middle Name:SUL
Last Name:LEE-JUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SUL
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8202 CLEARVISTA PKWY STE 9F
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1457
Mailing Address - Country:US
Mailing Address - Phone:317-204-4285
Mailing Address - Fax:317-889-9127
Practice Address - Street 1:8202 CLEARVISTA PKWY STE 9F
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1457
Practice Address - Country:US
Practice Address - Phone:317-204-4285
Practice Address - Fax:317-204-4819
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003036A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor