Provider Demographics
NPI:1083949887
Name:MACEDO, RYAN BAXTER (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BAXTER
Last Name:MACEDO
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 1:2100 SE 164TH AVE
Mailing Address - Street 2:SUITE C-102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-258-0264
Mailing Address - Fax:360-254-0930
Practice Address - Street 1:2100 SE 164TH AVE
Practice Address - Street 2:SUITE C102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8934
Practice Address - Country:US
Practice Address - Phone:360-258-0264
Practice Address - Fax:360-254-0930
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60109615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor