Provider Demographics
NPI:1164512810
Name:RYAN, ROBERT PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:RYAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:655 CREEKSIDE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1292
Mailing Address - Country:US
Mailing Address - Phone:256-832-0077
Mailing Address - Fax:256-832-8797
Practice Address - Street 1:655 CREEKSIDE DR
Practice Address - Street 2:SUITE H
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1292
Practice Address - Country:US
Practice Address - Phone:256-832-0077
Practice Address - Fax:256-832-8797
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68565Medicare UPIN