Provider Demographics
NPI:1689739203
Name:RYAN, MICHAEL T III (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:RYAN
Suffix:III
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 1:9 NAHANT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3221
Mailing Address - Country:US
Mailing Address - Phone:781-595-6560
Mailing Address - Fax:781-595-6580
Practice Address - Street 1:9 NAHANT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3221
Practice Address - Country:US
Practice Address - Phone:781-595-6560
Practice Address - Fax:781-595-6580
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA37960OtherHARVARD PILGRIM ID
MA2808856OtherCIGNA ID
MAY36671OtherBC BS OF MA PROVIDER ID
MA2223887OtherAETNA ID
MA409472OtherTUFTS ID
MAY45318Medicare ID - Type UnspecifiedPROVIDER ID