Provider Demographics
NPI:1790067593
Name:BATES, RYAN LEE (D C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:BATES
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7591 FERN AVE STE 1502
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5748
Mailing Address - Country:US
Mailing Address - Phone:318-220-8753
Mailing Address - Fax:318-220-8764
Practice Address - Street 1:7591 FERN AVE STE 1502
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5748
Practice Address - Country:US
Practice Address - Phone:318-220-8753
Practice Address - Fax:318-220-8764
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor