Provider Demographics
NPI:1093051815
Name:CANAVAN, ANDREW RYAN (DC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RYAN
Last Name:CANAVAN
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 1:111 N. FISKE BLVD.
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922
Mailing Address - Country:US
Mailing Address - Phone:321-636-6090
Mailing Address - Fax:321-632-5805
Practice Address - Street 1:111 N. FISKE BLVD.
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922
Practice Address - Country:US
Practice Address - Phone:321-636-6090
Practice Address - Fax:321-632-5805
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor