Provider Demographics
NPI:1972906832
Name:GAWRON, RYAN JON (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JON
Last Name:GAWRON
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 1:12211 S HARLEM AVE STE 1S
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1471
Mailing Address - Country:US
Mailing Address - Phone:708-671-8082
Mailing Address - Fax:708-777-4764
Practice Address - Street 1:12211 S HARLEM AVE STE 1S
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1471
Practice Address - Country:US
Practice Address - Phone:708-671-8082
Practice Address - Fax:708-777-4764
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor