Provider Demographics
NPI:1013644301
Name:100 CHIRO RYAN FOUR, LLC
Entity Type:Organization
Organization Name:100 CHIRO RYAN FOUR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FRANCHISEE
Authorized Official - Prefix:
Authorized Official - First Name:DR SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-509-3900
Mailing Address - Street 1:4279 S HIGHWAY 27 STE J
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4279 S HIGHWAY 27 STE J
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5415
Practice Address - Country:US
Practice Address - Phone:710-217-0895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty