Provider Demographics
NPI:1306474242
Name:JILL RUESCH-LANE, D.C. A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:JILL RUESCH-LANE, D.C. A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUESCH-LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-841-6507
Mailing Address - Street 1:6404 WILSHIRE BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5509
Mailing Address - Country:US
Mailing Address - Phone:323-841-6507
Mailing Address - Fax:323-653-2720
Practice Address - Street 1:6404 WILSHIRE BLVD STE 701
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5509
Practice Address - Country:US
Practice Address - Phone:323-841-6507
Practice Address - Fax:323-653-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty