Provider Demographics
NPI:1629020656
Name:KONARIK, RYAN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:KONARIK
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 1:15010 FM 2100 RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-8119
Mailing Address - Country:US
Mailing Address - Phone:281-462-2500
Mailing Address - Fax:281-462-2544
Practice Address - Street 1:15010 FM 2100 RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-8119
Practice Address - Country:US
Practice Address - Phone:281-462-2500
Practice Address - Fax:281-462-2544
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor