Provider Demographics
NPI:1740401785
Name:LY, ADRIENNE (DC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 W. HARRIET LANE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:562-698-2411
Mailing Address - Fax:562-698-2420
Practice Address - Street 1:13019 BAILEY AVE., STE. F
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601
Practice Address - Country:US
Practice Address - Phone:562-698-2411
Practice Address - Fax:562-698-2420
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor