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General NPI Number Information
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NPI Number | 1639715352
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Entity Type | Organization
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Legal Business Name | JACK LI, D.C., A CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 12340 SANTA MONICA BLVD STE 129
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City | LOS ANGELES
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State | CA
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Zip | 90025-2584
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Country | US
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Telephone | 310-207-1007
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Fax | 310-633-8338
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Provider Business Mailing Address
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Address Line | 12340 SANTA MONICA BLVD STE 129
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City | LOS ANGELES
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State | CA
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Zip | 90025-2584
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Country | US
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Telephone | 310-207-1007
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Fax | 310-633-8338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK T LI
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Credential | DC
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Telephone | 310-207-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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