Provider Demographics
NPI:1700823770
Name:RYAN, IRENE M (DC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-3569
Mailing Address - Country:US
Mailing Address - Phone:609-345-3686
Mailing Address - Fax:609-345-3698
Practice Address - Street 1:25 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-3569
Practice Address - Country:US
Practice Address - Phone:609-345-3686
Practice Address - Fax:609-345-3698
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00191400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0116918000OtherAMERIHEALTH
NJRY542916OtherHORIZON
NJRY542916OtherHORIZON