Provider Demographics
NPI:1326371774
Name:FOOTIT, RYAN RANDAL (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RANDAL
Last Name:FOOTIT
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 1:1070 W MAIN ST
Mailing Address - Street 2:#909
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2858
Mailing Address - Country:US
Mailing Address - Phone:612-281-1063
Mailing Address - Fax:
Practice Address - Street 1:1070 W MAIN ST
Practice Address - Street 2:#909
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2858
Practice Address - Country:US
Practice Address - Phone:612-281-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor