Provider Demographics
NPI:1972694453
Name:LEE, JUDY LANG (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:LANG
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:LANG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:10150 TOPEKA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1226
Mailing Address - Country:US
Mailing Address - Phone:818-620-1358
Mailing Address - Fax:818-717-8470
Practice Address - Street 1:5567 RESEDA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2648
Practice Address - Country:US
Practice Address - Phone:213-387-4710
Practice Address - Fax:213-387-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15287111N00000X
CAAC2914171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist