Provider Demographics
NPI:1235219056
Name:WILLE, RYAN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:WILLE
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 1:1 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:JOBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08041-2028
Mailing Address - Country:US
Mailing Address - Phone:609-265-7727
Mailing Address - Fax:609-265-7079
Practice Address - Street 1:1 PINE TREE LN
Practice Address - Street 2:
Practice Address - City:JOBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08041-2028
Practice Address - Country:US
Practice Address - Phone:609-265-7727
Practice Address - Fax:609-265-7079
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
877429Medicare ID - Type UnspecifiedRYAN WILLE
62113Medicare UPIN
080873Medicare ID - Type UnspecifiedMEDICARE GROUP