Provider Demographics
NPI:1497987853
Name:TICHAUER, RYAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:TICHAUER
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 1:6608 102ND ST
Mailing Address - Street 2:6F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4520
Mailing Address - Country:US
Mailing Address - Phone:718-300-9623
Mailing Address - Fax:
Practice Address - Street 1:6361 99TH ST
Practice Address - Street 2:1G
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2409
Practice Address - Country:US
Practice Address - Phone:718-300-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor