Provider Demographics
NPI:1942432554
Name:LEE, RYAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:S
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 1:118 BROAD AVE
Mailing Address - Street 2:# N10
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2717
Mailing Address - Country:US
Mailing Address - Phone:201-585-8300
Mailing Address - Fax:201-585-8301
Practice Address - Street 1:1638 SCHLOSSER ST STE D4
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-585-8300
Practice Address - Fax:201-585-8301
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00671900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor