Provider Demographics
NPI:1053471573
Name:THORNTON, RYAN D (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:THORNTON
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 1:8194 BYRON CENTER AVE SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9401
Mailing Address - Country:US
Mailing Address - Phone:616-583-7810
Mailing Address - Fax:616-583-0150
Practice Address - Street 1:8194 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9401
Practice Address - Country:US
Practice Address - Phone:616-583-7810
Practice Address - Fax:616-583-0150
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D114170OtherBLUE CROSS BLUE SHIELD
MA202066577OtherTAX IDENTIFICATION #
MIP09980001Medicare ID - Type Unspecified