Provider Demographics
NPI:1396832689
Name:PERRY, RYAN EDWARD (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:PERRY
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ARTESIA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2755
Mailing Address - Country:US
Mailing Address - Phone:310-374-9025
Mailing Address - Fax:310-379-5748
Practice Address - Street 1:1200 ARTESIA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2755
Practice Address - Country:US
Practice Address - Phone:310-374-9025
Practice Address - Fax:310-379-5748
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor