Provider Demographics
NPI:1568629483
Name:LY, LAM CHI
Entity Type:Individual
Prefix:
First Name:LAM
Middle Name:CHI
Last Name:LY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 MAPLE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2408
Mailing Address - Country:US
Mailing Address - Phone:214-526-3878
Mailing Address - Fax:214-526-4994
Practice Address - Street 1:4343 MAPLE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2408
Practice Address - Country:US
Practice Address - Phone:214-526-3878
Practice Address - Fax:214-526-4994
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor