Provider Demographics
NPI:1013480706
Name:DONAHUE, RYAN (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DONAHUE
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 1:6240 NW 106TH ST APT 110
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2463
Mailing Address - Country:US
Mailing Address - Phone:712-251-5737
Mailing Address - Fax:
Practice Address - Street 1:2555 BERKSHIRE PKWY STE F
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4646
Practice Address - Country:US
Practice Address - Phone:515-987-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor