Provider Demographics
NPI:1659468551
Name:RADEMACKER, RYAN P (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:RADEMACKER
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 1:23 NORTH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1053
Mailing Address - Country:US
Mailing Address - Phone:585-394-8430
Mailing Address - Fax:585-394-8154
Practice Address - Street 1:23 NORTH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1053
Practice Address - Country:US
Practice Address - Phone:585-394-8430
Practice Address - Fax:585-394-8154
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010717-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY838800OtherMANANGED PHYICAL NETWORK
NY838800OtherMANANGED PHYICAL NETWORK