Provider Demographics
NPI:1639188790
Name:LEE, TAEHO (DO)
Entity type:Individual
Prefix:MR
First Name:TAEHO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E. NORTHWEST HWY
Mailing Address - Street 2:UNITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9998
Mailing Address - Country:US
Mailing Address - Phone:817-552-7246
Mailing Address - Fax:682-271-4149
Practice Address - Street 1:821 E. NORTHWEST HWY
Practice Address - Street 2:UNITE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9998
Practice Address - Country:US
Practice Address - Phone:817-552-7246
Practice Address - Fax:682-271-4149
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202511138OtherGROUP ORGANIZATIONS TYPE