Provider Demographics
NPI:1114258498
Name:RYAN CHIROPRACTIC
Entity Type:Organization
Organization Name:RYAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:781-595-6560
Mailing Address - Street 1:9 NAHANT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3221
Mailing Address - Country:US
Mailing Address - Phone:781-595-6560
Mailing Address - Fax:781-595-6580
Practice Address - Street 1:9 NAHANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3221
Practice Address - Country:US
Practice Address - Phone:781-595-6560
Practice Address - Fax:781-595-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2808856OtherCIGNA
MA2223887OtherAETNA
MA409472OtherTUFTS
MAY36671OtherBLUE CROSS BLUE SHIELD
MA409472OtherTUFTS