Provider Demographics
NPI:1396234613
Name:LEE, SANGSOO (DC)
Entity type:Individual
Prefix:
First Name:SANGSOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 DULUTH HIGHWAY 120 STE 110
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4504
Mailing Address - Country:US
Mailing Address - Phone:770-545-8288
Mailing Address - Fax:770-545-8286
Practice Address - Street 1:2148 DULUTH HIGHWAY 120 STE 110
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4504
Practice Address - Country:US
Practice Address - Phone:770-545-8288
Practice Address - Fax:770-545-8286
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor