Provider Demographics
NPI:1619112570
Name:FRALICK, RYAN DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DEAN
Last Name:FRALICK
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 1:10 CONEWANGO AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2529
Mailing Address - Country:US
Mailing Address - Phone:814-723-2060
Mailing Address - Fax:814-723-6244
Practice Address - Street 1:10 CONEWANGO AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2529
Practice Address - Country:US
Practice Address - Phone:814-723-2060
Practice Address - Fax:814-723-6244
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001212111N00000X
PADC010032111N00000X
PAAJ009847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor