MEDICARE: DR. RYAN LAVANCE LEE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3045	TN

General Provider Information

NPI Number	:	1164932828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN LAVANCE LEE DC

Provider Business Mailing Address
First Line	:	PO BOX 2362
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-2362
Country	:	US
Telephone Number	:	423-498-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5564 LITTLE DEBBIE PKWY STE 108
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-4356
Country	:	US
Telephone Number	:	423-498-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	06/10/2020

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