MEDICARE: DR. JUN YUP LEE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00677700	NJ

General Provider Information

NPI Number	:	1083936470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUN YUP LEE D.C.

Provider Business Mailing Address
First Line	:	669 BROAD AVE STE 201
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1631
Country	:	US
Telephone Number	:	201-585-1020
Fax Number	:	201-917-3588

Provider Business Practice Location Address
First Line	:	669 BROAD AVE STE 201
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1631
Country	:	US
Telephone Number	:	201-585-1020
Fax Number	:	201-917-3588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	01/28/2020

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