Provider Demographics
NPI:1891732517
Name:HOUSE, RYAN WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WAYNE
Last Name:HOUSE
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 1:1633 W MAIN ST
Mailing Address - Street 2:#401
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3423
Mailing Address - Country:US
Mailing Address - Phone:615-444-2234
Mailing Address - Fax:615-547-4849
Practice Address - Street 1:1633 W MAIN ST
Practice Address - Street 2:#401
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3423
Practice Address - Country:US
Practice Address - Phone:615-444-2234
Practice Address - Fax:615-547-4849
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734252OtherMEDICARE PTAN