Provider Demographics
NPI:1558344754
Name:FORD, RYAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:S
Last Name:FORD
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 1:564 SEDONA CT
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-8064
Mailing Address - Country:US
Mailing Address - Phone:417-793-5475
Mailing Address - Fax:
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1849
Practice Address - Country:US
Practice Address - Phone:864-230-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4384111N00000X
MO2003013226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200086OtherBLUE CROSS / BLUE SHIELD
MO200086OtherBLUE CROSS / BLUE SHIELD
MOY42076Medicare UPIN