Provider Demographics
NPI:1669431458
Name:LEE, CHANG-JUI (DC)
Entity type:Individual
Prefix:DR
First Name:CHANG-JUI
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:PO BOX 3334
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3334
Mailing Address - Country:US
Mailing Address - Phone:425-235-9901
Mailing Address - Fax:425-235-1132
Practice Address - Street 1:106 LAKE AVE SOUTH
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-235-9901
Practice Address - Fax:425-235-1132
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034749111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08132084OtherBCBSIL
IL08132084OtherBCBSIL
WAG8867038Medicare PIN