Provider Demographics
NPI:1821350158
Name:LEE, RYAN JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAY
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 1:240 N VIRGIL AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5293
Mailing Address - Country:US
Mailing Address - Phone:213-389-1083
Mailing Address - Fax:
Practice Address - Street 1:240 N VIRGIL AVE STE 11
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5293
Practice Address - Country:US
Practice Address - Phone:213-389-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor