Provider Demographics
NPI:1255389441
Name:WAIND, RYAN T (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:WAIND
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 1:2222 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5312
Mailing Address - Country:US
Mailing Address - Phone:308-398-1900
Mailing Address - Fax:308-398-1901
Practice Address - Street 1:2222 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5312
Practice Address - Country:US
Practice Address - Phone:308-398-1900
Practice Address - Fax:308-398-1901
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04368318300Medicaid
NE99593OtherBCBS
NE275650Medicare ID - Type UnspecifiedIND
NEU78645Medicare UPIN
NE99593OtherBCBS