Provider Demographics
NPI:1437353901
Name:STUART, RYAN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ROBERT
Last Name:STUART
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 1:250 N GOLDEN CIRCLE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4021
Mailing Address - Country:US
Mailing Address - Phone:714-565-1005
Mailing Address - Fax:714-565-1008
Practice Address - Street 1:250 N GOLDEN CIRCLE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4021
Practice Address - Country:US
Practice Address - Phone:714-565-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV06465Medicare UPIN
CADC26656Medicare ID - Type Unspecified