Provider Demographics
NPI:1376695486
Name:RYAN, STEVEN T (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:T
Last Name:RYAN
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 1:14410 SE PETROVITSKY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8900
Mailing Address - Country:US
Mailing Address - Phone:425-226-1856
Mailing Address - Fax:425-226-0231
Practice Address - Street 1:14410 SE PETROVITSKY RD STE 109
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-226-1856
Practice Address - Fax:425-226-0231
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA18942OtherSTATE L&I
GAB04901Medicare ID - Type Unspecified
WA18942OtherSTATE L&I