Provider Demographics
NPI:1316185036
Name:RYAN GOETZ, P.A.
Entity Type:Organization
Organization Name:RYAN GOETZ, P.A.
Other - Org Name:WATERTOWN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-320-3841
Mailing Address - Street 1:204 LEWIS AVE S STE 203
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4502
Mailing Address - Country:US
Mailing Address - Phone:952-955-1974
Mailing Address - Fax:952-955-3249
Practice Address - Street 1:204 LEWIS AVE S
Practice Address - Street 2:SUTIE 203
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-4500
Practice Address - Country:US
Practice Address - Phone:515-320-3841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty