Provider Demographics
NPI:1235350109
Name:BETZINA, RYAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:BETZINA
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 1:7644 160TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4442
Mailing Address - Country:US
Mailing Address - Phone:952-985-5444
Mailing Address - Fax:952-314-4963
Practice Address - Street 1:7644 160TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4442
Practice Address - Country:US
Practice Address - Phone:952-985-5444
Practice Address - Fax:952-314-4963
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004187Medicare PIN