Provider Demographics
NPI:1639318363
Name:CONNELL, RYAN P (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:CONNELL
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 1:1485 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-1976
Mailing Address - Country:US
Mailing Address - Phone:563-219-8947
Mailing Address - Fax:563-219-8949
Practice Address - Street 1:1485 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-1976
Practice Address - Country:US
Practice Address - Phone:563-219-8947
Practice Address - Fax:563-219-8949
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076194111N00000X
AZ7984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor