Provider Demographics
NPI:1831630524
Name:LEE, DONGWOOK (DC)
Entity type:Individual
Prefix:
First Name:DONGWOOK
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 1:686 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3043
Mailing Address - Country:US
Mailing Address - Phone:678-765-8073
Mailing Address - Fax:678-765-8074
Practice Address - Street 1:686 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 210
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3043
Practice Address - Country:US
Practice Address - Phone:678-765-8073
Practice Address - Fax:678-765-8074
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor