Healthcare Provider Details

I. General information

NPI: 1164590121
Provider Name (Legal Business Name): JILL RUESCH-LANE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILSHIRE BLVD SUITE 701
LOS ANGELES CA
90048-5501
US

IV. Provider business mailing address

6404 WILSHIRE BLVD SUITE 701
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-3362
  • Fax: 323-653-2720
Mailing address:
  • Phone: 323-653-3362
  • Fax: 323-653-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: