Provider Demographics
NPI:1992859821
Name:MAYEDA, RYAN JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JEFFERY
Last Name:MAYEDA
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 1:4625 W 20TH ST UNIT 109
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3208
Mailing Address - Country:US
Mailing Address - Phone:973-673-7879
Mailing Address - Fax:
Practice Address - Street 1:4625 W 20TH ST UNIT 109
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:973-673-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor