Provider Demographics
NPI:1326244476
Name:GUTIERREZ, RYAN (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GUTIERREZ
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 1:4131 CAMINO COYOTE
Mailing Address - Street 2:STE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-3000
Mailing Address - Country:US
Mailing Address - Phone:575-521-1215
Mailing Address - Fax:
Practice Address - Street 1:4131 CAMINO COYOTE
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3000
Practice Address - Country:US
Practice Address - Phone:505-521-1215
Practice Address - Fax:505-521-1343
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor