Provider Demographics
NPI:1063835221
Name:NYE, RYAN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:NYE
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 1:1096 ERIKSON DR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5297
Mailing Address - Country:US
Mailing Address - Phone:208-656-3205
Mailing Address - Fax:208-656-3206
Practice Address - Street 1:1096 ERIKSON DR
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5297
Practice Address - Country:US
Practice Address - Phone:208-656-3205
Practice Address - Fax:208-656-3206
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor