Provider Demographics
NPI:1518678879
Name:MAIZE, RYAN GEORGE
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:GEORGE
Last Name:MAIZE
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 1:2850 SE POWELL VALLEY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1489
Mailing Address - Country:US
Mailing Address - Phone:503-489-1975
Mailing Address - Fax:
Practice Address - Street 1:2850 SE POWELL VALLEY RD STE 205
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1489
Practice Address - Country:US
Practice Address - Phone:503-489-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6263OtherSTATE LICENSE