Provider Demographics
NPI:1528007713
Name:PRICE, JOHN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RYAN
Last Name:PRICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:RYAN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PA
Mailing Address - Street 1:100 W SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 142, PMB # 800
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6100
Mailing Address - Country:US
Mailing Address - Phone:817-912-3331
Mailing Address - Fax:817-310-3291
Practice Address - Street 1:601 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6251
Practice Address - Country:US
Practice Address - Phone:817-912-3331
Practice Address - Fax:817-310-3291
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9820111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03735Medicare UPIN
TX611443Medicare ID - Type Unspecified