Provider Demographics
NPI:1477273191
Name:HARVEY, RYAN WILSON (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WILSON
Last Name:HARVEY
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 1:13911 RIDGEDALE DR STE 490
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1772
Mailing Address - Country:US
Mailing Address - Phone:612-223-8590
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 490
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1772
Practice Address - Country:US
Practice Address - Phone:612-223-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor