Provider Demographics
NPI:1114036159
Name:ROCK, RYAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:ROCK
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:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:KS
Mailing Address - Zip Code:66025-0706
Mailing Address - Country:US
Mailing Address - Phone:785-542-2118
Mailing Address - Fax:785-542-1164
Practice Address - Street 1:1402 CHURCH ST
Practice Address - Street 2:STE E
Practice Address - City:EUDORA
Practice Address - State:KS
Practice Address - Zip Code:66025-9489
Practice Address - Country:US
Practice Address - Phone:785-542-2118
Practice Address - Fax:785-542-1164
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00290537OtherRRMC PROVIDER NUMBER
KS11319888OtherCAQH PROVIDER #
KS35886021OtherBCBSKC
KS2195757OtherFIRST HEALTH PROVIDER #
KS665384OtherUNITED PROVIDER NUMBER
KS282759OtherCOVENTRY PROVIDER #
KS665384OtherUNITED PROVIDER NUMBER