Provider Demographics
NPI:1790951671
Name:PERKINS, RYAN BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BENJAMIN
Last Name:PERKINS
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 1:1354 E KINGSLEY ST
Mailing Address - Street 2:SUITE E.
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7216
Mailing Address - Country:US
Mailing Address - Phone:417-885-1200
Mailing Address - Fax:417-885-1202
Practice Address - Street 1:1354 E KINGSLEY ST
Practice Address - Street 2:SUITE E.
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7216
Practice Address - Country:US
Practice Address - Phone:417-885-1200
Practice Address - Fax:417-885-1202
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008011492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor