Provider Demographics
NPI:1851408033
Name:DAVIS, RYAN JAMES (D,C,)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2607
Mailing Address - Country:US
Mailing Address - Phone:218-326-1804
Mailing Address - Fax:218-326-7960
Practice Address - Street 1:204 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2607
Practice Address - Country:US
Practice Address - Phone:218-326-1804
Practice Address - Fax:218-326-7960
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU97827Medicare UPIN
MN350003015Medicare ID - Type Unspecified