Provider Demographics
NPI:1609977313
Name:SYVRUD, RYAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:S
Last Name:SYVRUD
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 1:825 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8724
Mailing Address - Country:US
Mailing Address - Phone:701-237-5150
Mailing Address - Fax:701-532-1211
Practice Address - Street 1:825 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8724
Practice Address - Country:US
Practice Address - Phone:701-237-5150
Practice Address - Fax:701-532-1211
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN715762OtherMEDICARE
MN63140SYOtherBLUE CROSS BLUE SHIELD MN
ND16342Medicaid
ND26293OtherBLUE CROSS BLUE SHIELD ND
MN653528300Medicaid
ND16342Medicaid