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General NPI Number Information
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NPI Number | 1568523868
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Entity Type | Individual
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Provider Name | PAUL LEONARD RIES D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 W. WHITE MOUNTAIN BLVD.
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City | LAKESIDE
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State | AZ
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Zip | 85929
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Country | US
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Telephone | 928-367-4640
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Fax | 928-367-5572
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Provider Business Mailing Address
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Address Line | 100 W. WHITE MOUNTAIN BLVD.
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City | LAKESIDE
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State | AZ
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Zip | 85929
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Country | US
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Telephone | 928-367-4640
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Fax | 928-367-5572
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 4205
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License Number State | AZ
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