Provider Demographics
NPI:1740987429
Name:RYAN, LAUREN (DC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 COUNTRY CLUB RD APT 150A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4205
Mailing Address - Country:US
Mailing Address - Phone:410-361-1806
Mailing Address - Fax:
Practice Address - Street 1:419 SE MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2675
Practice Address - Country:US
Practice Address - Phone:864-881-3693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor