Provider Demographics
NPI:1770664633
Name:WARNOCK, RYAN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MARK
Last Name:WARNOCK
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 1:500 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2211
Mailing Address - Country:US
Mailing Address - Phone:617-298-1776
Mailing Address - Fax:617-298-7366
Practice Address - Street 1:500 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2211
Practice Address - Country:US
Practice Address - Phone:617-298-1776
Practice Address - Fax:617-298-7366
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor