Provider Demographics
NPI:1396831046
Name:BAUER, RYAN T (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:BAUER
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 1:3201 PIONEERS BLVD STE 32
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5963
Mailing Address - Country:US
Mailing Address - Phone:402-484-8500
Mailing Address - Fax:402-484-8532
Practice Address - Street 1:3201 PIONEERS BLVD STE 32
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5963
Practice Address - Country:US
Practice Address - Phone:402-484-8500
Practice Address - Fax:402-484-8532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09512OtherBLUE CROSS BLUE SHIELD
NE651146OtherACN
NE100249716-00Medicaid
NE276282Medicare ID - Type UnspecifiedCHIROPRACTOR