Provider Demographics
NPI:1417285628
Name:RYAN, GRACE (DC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
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 1:4677 HAMMOCK CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-5318
Mailing Address - Country:US
Mailing Address - Phone:314-435-2386
Mailing Address - Fax:
Practice Address - Street 1:1499 W YAMATO RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4435
Practice Address - Country:US
Practice Address - Phone:561-208-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor