Provider Demographics
NPI:1386650141
Name:BAGLEY, RYAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:BAGLEY
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 1:13781 CR 27 C
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-9488
Mailing Address - Country:US
Mailing Address - Phone:419-258-2028
Mailing Address - Fax:
Practice Address - Street 1:102 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1083
Practice Address - Country:US
Practice Address - Phone:419-542-8247
Practice Address - Fax:419-542-6726
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2647890Medicaid
OH2647890Medicaid
OH4178831Medicare PIN