Provider Demographics
NPI:1376638403
Name:ELTON, RYAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:A
Last Name:ELTON
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 1:1421 WAYZATA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1939
Mailing Address - Country:US
Mailing Address - Phone:952-473-9637
Mailing Address - Fax:952-473-1850
Practice Address - Street 1:1421 WAYZATA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1939
Practice Address - Country:US
Practice Address - Phone:952-473-9637
Practice Address - Fax:952-473-1850
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002539Medicare ID - Type Unspecified
MNU88778Medicare UPIN