MEDICARE: DR. SEOK JOON 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	111NN1001X	Nutrition Chiropractor	DC 25589	CA

General Provider Information

NPI Number	:	1376853416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEOK JOON LEE D.C.

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	800-355-9689
Fax Number	:	800-993-7780

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	800-355-9689
Fax Number	:	800-993-7780

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

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	06/28/2011

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