Provider Demographics
NPI:1477682862
Name:KHEANG C. LY, CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:KHEANG C. LY, CHIROPRACTIC CORPORATION
Other - Org Name:RED HILL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHEANG
Authorized Official - Middle Name:C
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-518-2077
Mailing Address - Street 1:8977 FOOTHILL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3498
Mailing Address - Country:US
Mailing Address - Phone:989-909-0944
Mailing Address - Fax:909-980-9669
Practice Address - Street 1:8977 FOOTHILL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3498
Practice Address - Country:US
Practice Address - Phone:989-909-0944
Practice Address - Fax:909-980-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty