Provider Demographics
NPI:1922111897
Name:HASENCLEVER, RYAN DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DALE
Last Name:HASENCLEVER
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 1:902B S WALTON BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5770
Mailing Address - Country:US
Mailing Address - Phone:479-876-8628
Mailing Address - Fax:479-876-8643
Practice Address - Street 1:902B S WALTON BLVD STE 18
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5770
Practice Address - Country:US
Practice Address - Phone:479-876-8628
Practice Address - Fax:479-876-8643
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor