Provider Demographics
NPI:1407994320
Name:VIDRINE, RYAN JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:VIDRINE
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 1:326 SETTLERS TRACE BLVD # 201-C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6091
Mailing Address - Country:US
Mailing Address - Phone:337-270-0900
Mailing Address - Fax:337-270-0901
Practice Address - Street 1:326 SETTLERS TRACE BLVD # 201-C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6091
Practice Address - Country:US
Practice Address - Phone:337-270-0900
Practice Address - Fax:337-270-0901
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU93394Medicare UPIN