Provider Demographics
NPI:1205424587
Name:KIEHART, RYAN ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANTHONY
Last Name:KIEHART
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 1:2757 LOWER LAKE RD APT B
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-9429
Mailing Address - Country:US
Mailing Address - Phone:570-267-8327
Mailing Address - Fax:
Practice Address - Street 1:55 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2120
Practice Address - Country:US
Practice Address - Phone:315-342-6300
Practice Address - Fax:315-342-6302
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor