Provider Demographics
NPI:1386672079
Name:REEVES, RYAN R (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:R
Last Name:REEVES
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 1:1460 JEFFERSON STREET
Mailing Address - Street 2:SUITE A P.O.BOX 11
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123
Mailing Address - Country:US
Mailing Address - Phone:937-981-1992
Mailing Address - Fax:
Practice Address - Street 1:1460 JEFFERSON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123
Practice Address - Country:US
Practice Address - Phone:937-981-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7638742OtherGROUP AETNA
OH432084906-00OtherGROUP WORKERS COMP
OH7491626OtherINDIVIDUAL AETNA
OH7491626OtherINDIVIDUAL AETNA
OH7638742OtherGROUP AETNA