Provider Demographics
NPI:1336101781
Name:METIVIER, RYAN ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ARTHUR
Last Name:METIVIER
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 1:1300 MINOT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3724
Mailing Address - Country:US
Mailing Address - Phone:207-782-2600
Mailing Address - Fax:207-782-1331
Practice Address - Street 1:1300 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3724
Practice Address - Country:US
Practice Address - Phone:207-782-2600
Practice Address - Fax:207-782-1331
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133980099Medicaid
MEMM8292Medicare ID - Type Unspecified