Provider Demographics
NPI:1669522504
Name:COOGAN, RYAN SEAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SEAN
Last Name:COOGAN
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 1:11902 97TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1882
Mailing Address - Country:US
Mailing Address - Phone:425-821-4600
Mailing Address - Fax:425-821-4622
Practice Address - Street 1:11902 97TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-1882
Practice Address - Country:US
Practice Address - Phone:425-821-4600
Practice Address - Fax:425-821-4622
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859725Medicare PIN