Provider Demographics
NPI:1801938147
Name:LEE, JOSEPH SEONG (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SEONG
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 1:8058 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2407
Mailing Address - Country:US
Mailing Address - Phone:763-425-1855
Mailing Address - Fax:763-425-1861
Practice Address - Street 1:8058 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2407
Practice Address - Country:US
Practice Address - Phone:763-425-1855
Practice Address - Fax:763-425-1861
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV05715Medicare UPIN