Provider Demographics
NPI:1396179479
Name:RYAN, TYLER D (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:D
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 1:228 KUULEI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2720
Mailing Address - Country:US
Mailing Address - Phone:808-261-8181
Mailing Address - Fax:808-261-7770
Practice Address - Street 1:228 KUULEI RD
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2720
Practice Address - Country:US
Practice Address - Phone:808-261-8181
Practice Address - Fax:808-261-7770
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor