Provider Demographics
NPI:1720397391
Name:CASAGRANDA, RYAN ANTONEY (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANTONEY
Last Name:CASAGRANDA
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 1:45 COMMODORE LN
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1600
Mailing Address - Country:US
Mailing Address - Phone:860-910-7880
Mailing Address - Fax:774-521-3027
Practice Address - Street 1:102 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4607
Practice Address - Country:US
Practice Address - Phone:617-720-1992
Practice Address - Fax:617-248-9916
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor