MEDICARE: DR. RYAN KLEE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH 11362	FL
2	111N00000X	Chiropractor	X012539	NY
3	111N00000X	Chiropractor	F1-0000912	DE

General Provider Information

NPI Number	:	1174921464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN KLEE D.C.

Provider Business Mailing Address
First Line	:	4104 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5239
Country	:	US
Telephone Number	:	813-229-2225
Fax Number	:	813-221-2225

Provider Business Practice Location Address
First Line	:	4104 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5239
Country	:	US
Telephone Number	:	813-229-2225
Fax Number	:	813-221-2225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	11/10/2015

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