Provider Demographics
NPI:1760614192
Name:EFFERTZ, RYAN JAMES
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:EFFERTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-2368
Mailing Address - Country:US
Mailing Address - Phone:715-532-5643
Mailing Address - Fax:
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2231
Practice Address - Country:US
Practice Address - Phone:715-234-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI452412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor