Provider Demographics
NPI:1508169814
Name:DAVIS, RYAN WALSH (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WALSH
Last Name:DAVIS
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 1:12205 COUNTY LINE RD
Mailing Address - Street 2:D
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7719
Mailing Address - Country:US
Mailing Address - Phone:256-461-7775
Mailing Address - Fax:256-461-7756
Practice Address - Street 1:12205 COUNTY LINE RD
Practice Address - Street 2:D
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7719
Practice Address - Country:US
Practice Address - Phone:256-461-7775
Practice Address - Fax:256-461-7756
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2318111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation