Healthcare Provider Details

I. General information

NPI: 1306474242
Provider Name (Legal Business Name): JILL RUESCH-LANE, D.C. A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 WILSHIRE BLVD STE 701
LOS ANGELES CA
90048-5509
US

IV. Provider business mailing address

6404 WILSHIRE BLVD STE 701
LOS ANGELES CA
90048-5509
US

V. Phone/Fax

Practice location:
  • Phone: 323-841-6507
  • Fax: 323-653-2720
Mailing address:
  • Phone: 323-841-6507
  • Fax: 323-653-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JILL RUESCH-LANE
Title or Position: CEO
Credential: D.C.
Phone: 323-841-6507