Provider Demographics
NPI:1730293994
Name:BRINKA, RYAN C (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:BRINKA
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 1:940 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1606
Mailing Address - Country:US
Mailing Address - Phone:630-761-8566
Mailing Address - Fax:630-761-8568
Practice Address - Street 1:940 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1606
Practice Address - Country:US
Practice Address - Phone:630-761-8566
Practice Address - Fax:630-761-8568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532071OtherBCBS PROVIDER NUMBER
IL04532071OtherBCBS PROVIDER NUMBER
ILU93093Medicare UPIN