Provider Demographics
NPI:1184041337
Name:HANSTAD, RYAN LEE (DC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEE
Last Name:HANSTAD
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 1:4341 BIRCH STREET
Mailing Address - Street 2:#100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-398-6353
Mailing Address - Fax:949-398-6354
Practice Address - Street 1:4341 BIRCH STREET
Practice Address - Street 2:#100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-398-6353
Practice Address - Fax:949-398-6354
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor