Provider Demographics
NPI:1164795142
Name:GARCIA, RYAN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:GARCIA
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 1:35008 EMERALD COAST PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4754
Mailing Address - Country:US
Mailing Address - Phone:850-654-6912
Mailing Address - Fax:850-654-9459
Practice Address - Street 1:35008 EMERALD COAST PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4754
Practice Address - Country:US
Practice Address - Phone:850-654-6912
Practice Address - Fax:850-654-9459
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM188ZMedicare PIN