Provider Demographics
NPI:1013093129
Name:DEVRIES, RYNE D (DC)
Entity Type:Individual
Prefix:DR
First Name:RYNE
Middle Name:D
Last Name:DEVRIES
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 1:4748 CHICAGO AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-4311
Mailing Address - Country:US
Mailing Address - Phone:612-492-1961
Mailing Address - Fax:
Practice Address - Street 1:4847 CHICAGO AVE
Practice Address - Street 2:STE 10
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4311
Practice Address - Country:US
Practice Address - Phone:612-492-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2609111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116055900Medicaid
MN116055900Medicaid
MN350003358Medicare ID - Type Unspecified