Provider Demographics
NPI:1558367151
Name:HOKANSON, RYAN JON (DC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JON
Last Name:HOKANSON
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 1:429 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2806
Mailing Address - Country:US
Mailing Address - Phone:218-829-8200
Mailing Address - Fax:218-829-8201
Practice Address - Street 1:429 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2806
Practice Address - Country:US
Practice Address - Phone:218-829-8200
Practice Address - Fax:218-829-8201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80988HEOtherBCBS
U92370Medicare UPIN