Provider Demographics
NPI:1164539896
Name:SMART, RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:SMART
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 1:1016 NE FOREST ROCK LN STE 105
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9040
Mailing Address - Country:US
Mailing Address - Phone:360-779-5580
Mailing Address - Fax:
Practice Address - Street 1:9119 RIDGETOP BLVD NW STE 160
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8549
Practice Address - Country:US
Practice Address - Phone:360-215-7246
Practice Address - Fax:360-215-7282
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1164539896Medicaid