Provider Demographics
NPI:1114525748
Name:CLARK, RYAN SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:CLARK
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 1:1416 N REDWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6455
Mailing Address - Country:US
Mailing Address - Phone:801-753-8481
Mailing Address - Fax:801-331-8426
Practice Address - Street 1:1416 N REDWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6455
Practice Address - Country:US
Practice Address - Phone:801-753-8481
Practice Address - Fax:801-331-8426
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10652036-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor