Provider Demographics
NPI:1619560745
Name:BENGTSON, RYAN MILTON (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MILTON
Last Name:BENGTSON
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 1:1160 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1677
Mailing Address - Country:US
Mailing Address - Phone:815-382-6212
Mailing Address - Fax:
Practice Address - Street 1:999 N PLAZA DR STE 115
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5403
Practice Address - Country:US
Practice Address - Phone:847-706-9600
Practice Address - Fax:847-760-9610
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor