Provider Demographics
NPI:1821044322
Name:KEDDY, RYAN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANDREW
Last Name:KEDDY
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 1:850 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1429
Mailing Address - Country:US
Mailing Address - Phone:315-493-2225
Mailing Address - Fax:315-493-2224
Practice Address - Street 1:850 STATE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1429
Practice Address - Country:US
Practice Address - Phone:315-493-2225
Practice Address - Fax:315-493-2224
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor