Provider Demographics
NPI:1093763476
Name:RYAN, ALICE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 IRON HORSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4331
Mailing Address - Country:US
Mailing Address - Phone:843-875-1626
Mailing Address - Fax:843-913-8376
Practice Address - Street 1:3525 IRON HORSE RD STE 105
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4331
Practice Address - Country:US
Practice Address - Phone:843-875-1626
Practice Address - Fax:843-913-8376
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3111111N00000X
SC3111SC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3111Medicaid
AA13379049Medicare PIN