Provider Demographics
NPI:1548564982
Name:SPICUZZO, RYAN EMMANUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EMMANUEL
Last Name:SPICUZZO
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 1:2125 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3132
Mailing Address - Country:US
Mailing Address - Phone:561-797-5132
Mailing Address - Fax:954-697-0497
Practice Address - Street 1:100 S MILITARY TRL STE 33
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3032
Practice Address - Country:US
Practice Address - Phone:954-570-4080
Practice Address - Fax:954-697-0497
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10306111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor