Provider Demographics
NPI:1700973013
Name:LEE, JONGHO (DC)
Entity Type:Individual
Prefix:DR
First Name:JONGHO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JONG HO
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:675 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1045
Mailing Address - Country:US
Mailing Address - Phone:847-298-4470
Mailing Address - Fax:847-298-4472
Practice Address - Street 1:675 N WOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1045
Practice Address - Country:US
Practice Address - Phone:847-298-4470
Practice Address - Fax:847-298-4472
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor