Provider Demographics
NPI:1780816389
Name:JOHNSON, RYAN DAVID (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:JOHNSON
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 1:3209 E 57TH AVE
Mailing Address - Street 2:STE F
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7040
Mailing Address - Country:US
Mailing Address - Phone:509-868-0458
Mailing Address - Fax:509-868-0489
Practice Address - Street 1:3209 E 57TH AVE
Practice Address - Street 2:STE F
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7040
Practice Address - Country:US
Practice Address - Phone:509-868-0458
Practice Address - Fax:509-868-0489
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1380111N00000X
WACH-60130771111N00000X
WATT60136312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8890368Medicare PIN