Provider Demographics
NPI:1477678548
Name:RYAN, BENJAMIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:M
Last Name:RYAN
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 1:19 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2042
Mailing Address - Country:US
Mailing Address - Phone:978-352-7882
Mailing Address - Fax:
Practice Address - Street 1:65 CENTRAL ST
Practice Address - Street 2:SUITE A
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2425
Practice Address - Country:US
Practice Address - Phone:978-352-4200
Practice Address - Fax:978-352-4201
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7878555OtherAETNA INDIVIDUAL NUMBER
MAAA39676OtherHARVARD PILGRIM ID
MAY37069OtherBCBS INDIVIDUAL NUMBER
MAY39865OtherBCBS GROUP NUMBER
MA8669522OtherCIGNA INDIVIDUAL NUMBER
MA8669522OtherCIGNA INDIVIDUAL NUMBER