Provider Demographics
NPI:1023180130
Name:RYAN, PATRICK KEIR (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEIR
Last Name:RYAN
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 1:6042 N FRESNO ST
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5279
Mailing Address - Country:US
Mailing Address - Phone:559-224-6754
Mailing Address - Fax:559-490-0105
Practice Address - Street 1:6042 N FRESNO ST
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5279
Practice Address - Country:US
Practice Address - Phone:559-224-6754
Practice Address - Fax:559-490-0105
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24210111N00000X, 111NR0400X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU72574Medicare UPIN
CADC0242100Medicare ID - Type Unspecified