Provider Demographics
NPI:1760934202
Name:PEADEN, RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:PEADEN
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 1:8341 KOWALIGA RD
Mailing Address - Street 2:
Mailing Address - City:ECLECTIC
Mailing Address - State:AL
Mailing Address - Zip Code:36024-3749
Mailing Address - Country:US
Mailing Address - Phone:334-458-2633
Mailing Address - Fax:
Practice Address - Street 1:8341 KOWALIGA RD
Practice Address - Street 2:
Practice Address - City:ECLECTIC
Practice Address - State:AL
Practice Address - Zip Code:36024-3749
Practice Address - Country:US
Practice Address - Phone:334-458-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor