Provider Demographics
NPI:1477802338
Name:RYDER CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:RYDER CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAMSEY
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-362-6600
Mailing Address - Street 1:960 BARRINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9043
Mailing Address - Country:US
Mailing Address - Phone:319-362-6600
Mailing Address - Fax:319-377-8180
Practice Address - Street 1:960 BARRINGTON PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-9043
Practice Address - Country:US
Practice Address - Phone:319-362-6600
Practice Address - Fax:319-377-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0701868Medicaid
IA0701868Medicaid