Healthcare Provider Details

I. General information

NPI: 1174921464
Provider Name (Legal Business Name): RYAN KLEE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 W LINEBAUGH AVE
TAMPA FL
33624-5239
US

IV. Provider business mailing address

4104 W LINEBAUGH AVE
TAMPA FL
33624-5239
US

V. Phone/Fax

Practice location:
  • Phone: 813-229-2225
  • Fax: 813-221-2225
Mailing address:
  • Phone: 813-229-2225
  • Fax: 813-221-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11362
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX012539
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000912
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: