Provider Demographics
NPI:1407094238
Name:POYNOR, RYAN EDWARD
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:POYNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-0572
Mailing Address - Country:US
Mailing Address - Phone:870-238-8707
Mailing Address - Fax:870-238-8711
Practice Address - Street 1:1901 KILLOUGH RD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4112
Practice Address - Country:US
Practice Address - Phone:870-238-8707
Practice Address - Fax:870-238-8711
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor