Provider Demographics
NPI:1174677512
Name:RYAN, PATRICK TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:TIMOTHY
Last Name:RYAN
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 1:961 ROUTE 10 EAST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-252-6040
Mailing Address - Fax:973-252-6050
Practice Address - Street 1:961 ROUTE 10 EAST
Practice Address - Street 2:BOX 6
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-252-6040
Practice Address - Fax:973-252-6050
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 05268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor