Provider Demographics
NPI:1942767512
Name:RYAN BLOSSEY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:RYAN BLOSSEY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-379-3311
Mailing Address - Street 1:5241 LAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1953
Mailing Address - Country:US
Mailing Address - Phone:714-379-3311
Mailing Address - Fax:714-379-3313
Practice Address - Street 1:5241 LAMPSON AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1953
Practice Address - Country:US
Practice Address - Phone:714-379-3311
Practice Address - Fax:714-379-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty