Provider Demographics
NPI:1710037577
Name:RYAN, BRUCE HARLAN (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:HARLAN
Last Name:RYAN
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 1:18820 AURORA AVE N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3900
Mailing Address - Country:US
Mailing Address - Phone:206-546-2205
Mailing Address - Fax:206-533-6214
Practice Address - Street 1:18820 AURORA AVE N
Practice Address - Street 2:SUITE 102
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3900
Practice Address - Country:US
Practice Address - Phone:206-546-2205
Practice Address - Fax:206-533-6214
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA16782OtherLABOR & INDUSTRIES
WA2053403Medicaid
WARY0018OtherREGENCE BLUE SHIELD