Provider Demographics
NPI:1457517153
Name:LEE, YOHAN (DC)
Entity Type:Individual
Prefix:
First Name:YOHAN
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 1:3829 CHURCH RD
Mailing Address - Street 2:STE B
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1105
Mailing Address - Country:US
Mailing Address - Phone:856-234-1200
Mailing Address - Fax:856-234-1206
Practice Address - Street 1:10176 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:#201
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3650
Practice Address - Country:US
Practice Address - Phone:410-418-9000
Practice Address - Fax:410-418-9001
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00698800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor