Provider Demographics
NPI:1245215623
Name:MAIRS, RYAN JASON (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JASON
Last Name:MAIRS
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 1:104 22ND AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2641
Mailing Address - Country:US
Mailing Address - Phone:507-835-1600
Mailing Address - Fax:507-835-1609
Practice Address - Street 1:104 22ND AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2641
Practice Address - Country:US
Practice Address - Phone:507-835-1600
Practice Address - Fax:507-835-1609
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0726OtherHEALTH SERVICE MANAGEMENT
MN4447988OtherMEDICA
MN475329100Medicaid
MN606707OtherCHIROCARE
MN70D39MAOtherBCBSMN
MN4447988OtherMEDICA
MN475329100Medicaid