Provider Demographics
NPI:1528303203
Name:SELBY, STEVEN RYAN (DC LAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:RYAN
Last Name:SELBY
Suffix:
Gender:M
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 711
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:323-954-7400
Mailing Address - Fax:323-954-7402
Practice Address - Street 1:5757 WILSHIRE BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5810
Practice Address - Country:US
Practice Address - Phone:323-954-7400
Practice Address - Fax:323-954-7402
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31867111N00000X
CAAC 14127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist