MEDICARE: DONGHAK LEE DC

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	13986	TX

General Provider Information

NPI Number	:	1417420654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONGHAK LEE DC

Provider Business Mailing Address
First Line	:	2445 S BUCKNER BLVD STE 150
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-8704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 S BUCKNER BLVD STE 150
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-8704
Country	:	US
Telephone Number	:	972-727-6000
Fax Number	:

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “ DONGHAK LEE DC” Practice Location

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