Provider Demographics
NPI:1295164960
Name:RYAN STILSON CHIROPRACTIC INC
Entity type:Organization
Organization Name:RYAN STILSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-344-3938
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0006
Mailing Address - Country:US
Mailing Address - Phone:707-344-3938
Mailing Address - Fax:707-673-5827
Practice Address - Street 1:100 W AMERICAN CANYON RD
Practice Address - Street 2:STE. K-6
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-4194
Practice Address - Country:US
Practice Address - Phone:707-864-2223
Practice Address - Fax:707-673-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty