Provider Demographics
NPI:1083837934
Name:EMMETT, RYAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:EMMETT
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 1:30620 PACIFIC HWY S STE 105
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4888
Mailing Address - Country:US
Mailing Address - Phone:253-529-1886
Mailing Address - Fax:253-946-6357
Practice Address - Street 1:30620 PACIFIC HWY S STE 105
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4888
Practice Address - Country:US
Practice Address - Phone:253-529-1886
Practice Address - Fax:253-946-6357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA129173OtherLABOR & INDUSTRIES
WA129173OtherLABOR & INDUSTRIES