Provider Demographics
NPI:1659437309
Name:MATTHEW W. RYAN, DC PC
Entity Type:Organization
Organization Name:MATTHEW W. RYAN, DC PC
Other - Org Name:STEWART CLINIC OF WINDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-867-2225
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-0491
Mailing Address - Country:US
Mailing Address - Phone:770-867-2225
Mailing Address - Fax:770-867-7161
Practice Address - Street 1:206 E MAY ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-7127
Practice Address - Country:US
Practice Address - Phone:770-867-2225
Practice Address - Fax:770-867-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6573Medicare ID - Type Unspecified
GAU65328Medicare UPIN