Provider Demographics
NPI:1811001019
Name:BAUMAN, RYAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:S
Last Name:BAUMAN
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 1:733 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1247
Mailing Address - Country:US
Mailing Address - Phone:262-763-7373
Mailing Address - Fax:262-763-8184
Practice Address - Street 1:733 N PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1247
Practice Address - Country:US
Practice Address - Phone:262-763-7373
Practice Address - Fax:262-763-8184
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4178-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV08408Medicare UPIN