Provider Demographics
NPI:1770669806
Name:STILSON, RYAN ROYCE (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ROYCE
Last Name:STILSON
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 1:5030 BUSINESS CENTER DR
Mailing Address - Street 2:#295
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6874
Mailing Address - Country:US
Mailing Address - Phone:707-864-2223
Mailing Address - Fax:707-864-2224
Practice Address - Street 1:5030 BUSINESS CENTER DR
Practice Address - Street 2:#295
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-6874
Practice Address - Country:US
Practice Address - Phone:707-864-2223
Practice Address - Fax:707-864-2224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor