Provider Demographics
NPI:1467785733
Name:PORTERFIELD, RYAN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PAUL
Last Name:PORTERFIELD
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 1:503 SILHAVY RD
Mailing Address - Street 2:SUITE A104
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4494
Mailing Address - Country:US
Mailing Address - Phone:219-850-1031
Mailing Address - Fax:219-881-8237
Practice Address - Street 1:503 SILHAVY RD
Practice Address - Street 2:SUITE A104
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4494
Practice Address - Country:US
Practice Address - Phone:219-850-1031
Practice Address - Fax:219-881-8237
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002471A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1467785733Medicaid
IN1467785733Medicaid