Provider Demographics
NPI:1003095456
Name:RYCKMAN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RYCKMAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:RYCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-733-0310
Mailing Address - Street 1:5154 MILLER RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1065
Mailing Address - Country:US
Mailing Address - Phone:810-733-0310
Mailing Address - Fax:810-733-5554
Practice Address - Street 1:5154 MILLER RD
Practice Address - Street 2:SUITE J
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1065
Practice Address - Country:US
Practice Address - Phone:810-733-0310
Practice Address - Fax:810-733-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32768Medicare UPIN
MION82410Medicare PIN