Provider Demographics
NPI:1003929688
Name:RYAN, DAVID T (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:RYAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COMMERCE PARK DR
Mailing Address - Street 2:STE. A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8349
Mailing Address - Country:US
Mailing Address - Phone:614-890-8653
Mailing Address - Fax:614-890-2947
Practice Address - Street 1:6040 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231
Practice Address - Country:US
Practice Address - Phone:614-890-7952
Practice Address - Fax:614-890-8960
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1522111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114629Medicaid
OH0114629Medicaid
U27107Medicare UPIN