Provider Demographics
NPI:1801857008
Name:CALHOUN, RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:CALHOUN
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 1:1353 TIGER BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2632
Mailing Address - Country:US
Mailing Address - Phone:864-635-3928
Mailing Address - Fax:864-653-4949
Practice Address - Street 1:1353 TIGER BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2632
Practice Address - Country:US
Practice Address - Phone:864-635-3928
Practice Address - Fax:864-653-4949
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10082748111N00000X
SC2766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2766Medicaid
SCU93685Medicare UPIN
SCCH2766Medicaid