Provider Demographics
NPI:1932876877
Name:LEE, SEUNGJIN (DC)
Entity Type:Individual
Prefix:MR
First Name:SEUNGJIN
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 1:1920 WESTSIDE BLVD. STE. A
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-922-9444
Mailing Address - Fax:505-922-9150
Practice Address - Street 1:1920 WESTSIDE BLVD. STE. A
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-922-9444
Practice Address - Fax:505-922-9150
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor