Provider Demographics
NPI:1326133786
Name:BUELL, RYAN DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DENNIS
Last Name:BUELL
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-0008
Mailing Address - Country:US
Mailing Address - Phone:218-568-7767
Mailing Address - Fax:218-568-4580
Practice Address - Street 1:31095 BERGQUIST DRIVE
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-0008
Practice Address - Country:US
Practice Address - Phone:218-568-7767
Practice Address - Fax:218-568-4580
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3271111N00000X
IAAO5891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN659754OtherCHIRO CARE OF MN
MN40B23PEOtherBCBS OF MN
MN043813800Medicaid
MN41-1508205OtherHEALTH SERVICES MANAGEMEN
MNP00178997OtherRAILROAD MEDICARE
MNP00178997OtherRAILROAD MEDICARE
MN659754OtherCHIRO CARE OF MN