Provider Demographics
NPI:1376669341
Name:DONOVAN, RYAN DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DEAN
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:23220 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5225
Mailing Address - Country:US
Mailing Address - Phone:425-432-1449
Mailing Address - Fax:425-432-9910
Practice Address - Street 1:23220 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:SUITE 13
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5225
Practice Address - Country:US
Practice Address - Phone:425-432-1449
Practice Address - Fax:425-432-9910
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor