Provider Demographics
NPI:1336291012
Name:JEFFERY, RYAN C (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:JEFFERY
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 1:1037 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2805
Mailing Address - Country:US
Mailing Address - Phone:801-593-0999
Mailing Address - Fax:801-593-5458
Practice Address - Street 1:1037 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2805
Practice Address - Country:US
Practice Address - Phone:801-593-0999
Practice Address - Fax:801-593-5458
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294426-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056149Medicare ID - Type Unspecified