Provider Demographics
NPI:1740247881
Name:WEBSTER, RYAN FRANKLIN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:FRANKLIN
Last Name:WEBSTER
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 1:284 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8601
Mailing Address - Country:US
Mailing Address - Phone:208-265-9314
Mailing Address - Fax:
Practice Address - Street 1:476653 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9816
Practice Address - Country:US
Practice Address - Phone:208-265-9400
Practice Address - Fax:208-263-7521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU83563Medicare UPIN
ID1674592Medicare ID - Type Unspecified