Provider Demographics
NPI:1376690834
Name:JOHN RYAN PRICE, D.C., P.A.
Entity Type:Organization
Organization Name:JOHN RYAN PRICE, D.C., P.A.
Other - Org Name:PREMIER CHIROPRACTIC OF SOUTHLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-912-3331
Mailing Address - Street 1:731 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6377
Mailing Address - Country:US
Mailing Address - Phone:817-912-3331
Mailing Address - Fax:817-310-3291
Practice Address - Street 1:601 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6251
Practice Address - Country:US
Practice Address - Phone:817-912-3331
Practice Address - Fax:817-310-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9820111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty