Provider Demographics
NPI:1346029741
Name:BLACKMON, RYAN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WAYNE
Last Name:BLACKMON
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 1:5401 KENWOOD DR STE 117
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3181
Mailing Address - Country:US
Mailing Address - Phone:214-571-7246
Mailing Address - Fax:
Practice Address - Street 1:5401 KENWOOD DR STE 117
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3181
Practice Address - Country:US
Practice Address - Phone:214-571-7246
Practice Address - Fax:214-556-6900
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor