Provider Demographics
NPI:1982779005
Name:LEE, JUSTIN HEON (DC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:HEON
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:HEON
Other - Middle Name:JUSTIN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5712 E LAKE SAMMAMISH PKWY SE STE 106
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8943
Mailing Address - Country:US
Mailing Address - Phone:425-270-3392
Mailing Address - Fax:425-270-3394
Practice Address - Street 1:5712 E LAKE SAMMAMISH PKWY SE STE 106
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8943
Practice Address - Country:US
Practice Address - Phone:425-270-3392
Practice Address - Fax:425-270-3394
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor