Provider Demographics
NPI:1548565351
Name:DR. RYAN HASENCLEVER LLC
Entity Type:Organization
Organization Name:DR. RYAN HASENCLEVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HASENCLEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-621-9006
Mailing Address - Street 1:302 N 8TH ST
Mailing Address - Street 2:1
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3738
Mailing Address - Country:US
Mailing Address - Phone:479-621-9006
Mailing Address - Fax:479-621-9497
Practice Address - Street 1:302 N 8TH ST
Practice Address - Street 2:1
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3738
Practice Address - Country:US
Practice Address - Phone:479-621-9006
Practice Address - Fax:479-621-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A510Medicare UPIN