Provider Demographics
NPI:1598920498
Name:KELLEY, LEA (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3833
Mailing Address - Country:US
Mailing Address - Phone:310-545-6528
Mailing Address - Fax:310-545-6537
Practice Address - Street 1:3214 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3833
Practice Address - Country:US
Practice Address - Phone:310-545-6528
Practice Address - Fax:310-545-6537
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24997111N00000X
CAAC 9444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist