Provider Demographics
NPI:1790210391
Name:SCHROCK, RYAN T (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:T
Last Name:SCHROCK
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 1:101 CEDAR ROCK TRCE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-7701
Mailing Address - Country:US
Mailing Address - Phone:706-548-8984
Mailing Address - Fax:170-638-3778
Practice Address - Street 1:101 CEDAR ROCK TRCE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-7701
Practice Address - Country:US
Practice Address - Phone:706-548-8984
Practice Address - Fax:170-638-3778
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor