Provider Demographics
NPI:1891188314
Name:PRICE, TREVAN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVAN
Middle Name:RYAN
Last Name:PRICE
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 1:2107 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2165
Mailing Address - Country:US
Mailing Address - Phone:502-454-4441
Mailing Address - Fax:502-454-3999
Practice Address - Street 1:2107 WEBER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2165
Practice Address - Country:US
Practice Address - Phone:502-454-4441
Practice Address - Fax:502-454-3999
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNN/AOtherDO NOT HAVE SUCH NUMBERS ASSIGNED