Provider Demographics
NPI:1043280795
Name:STEWART, RYAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:STEWART
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 1:525 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3460
Mailing Address - Country:US
Mailing Address - Phone:615-449-6700
Mailing Address - Fax:615-449-0771
Practice Address - Street 1:525 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3460
Practice Address - Country:US
Practice Address - Phone:615-449-6700
Practice Address - Fax:615-449-0771
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1933111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970744Medicaid
TNU96762Medicare UPIN
TN3970744Medicare ID - Type Unspecified