Provider Demographics
NPI:1407989981
Name:RYAN, JO ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2302
Mailing Address - Country:US
Mailing Address - Phone:830-249-8377
Mailing Address - Fax:830-249-3974
Practice Address - Street 1:458 PAMELA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1226
Practice Address - Country:US
Practice Address - Phone:830-249-8377
Practice Address - Fax:830-249-3974
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC2514OtherPROVIDER ID
TX600804Medicaid
TX600804Medicaid