Provider Demographics
NPI:1487008165
Name:BURKHART, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BURKHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 BROADMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7329
Mailing Address - Country:US
Mailing Address - Phone:616-698-0046
Mailing Address - Fax:616-698-2188
Practice Address - Street 1:7101 BROADMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7329
Practice Address - Country:US
Practice Address - Phone:616-698-0046
Practice Address - Fax:616-698-2188
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor