Provider Demographics
NPI:1003916610
Name:VANROO, RYAN T (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:VANROO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0441
Mailing Address - Country:US
Mailing Address - Phone:608-756-5225
Mailing Address - Fax:
Practice Address - Street 1:2505 MILTON AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0441
Practice Address - Country:US
Practice Address - Phone:608-756-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3734-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38994700OtherMEDICAID GROUP
WI38929900Medicaid
U83425Medicare UPIN
WI38994700OtherMEDICAID GROUP