Healthcare Provider Details

I. General information

NPI: 1366910267
Provider Name (Legal Business Name): KOU LEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RANDOLPH RD
CHARLOTTE NC
28207-1126
US

IV. Provider business mailing address

2200 RANDOLPH RD
CHARLOTTE NC
28207-1126
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-9292
  • Fax:
Mailing address:
  • Phone: 704-372-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4989
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: