Provider Demographics
NPI:1366498602
Name:LOUNSBERRY, RYAN JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAY
Last Name:LOUNSBERRY
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 1:1812 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5283
Mailing Address - Country:US
Mailing Address - Phone:865-977-0916
Mailing Address - Fax:685-984-3519
Practice Address - Street 1:1812 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5283
Practice Address - Country:US
Practice Address - Phone:865-977-0916
Practice Address - Fax:685-984-3519
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4219754OtherBCBST
TN39704233Medicare PIN
TN4219754OtherBCBST
TNU75628Medicare UPIN
TN39704231Medicare PIN