Provider Demographics
NPI:1750354171
Name:KAUFFMAN, RYAN DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DANIEL
Last Name:KAUFFMAN
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 1:1136 JACKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3700
Mailing Address - Country:US
Mailing Address - Phone:408-262-1371
Mailing Address - Fax:408-262-1371
Practice Address - Street 1:1136 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3700
Practice Address - Country:US
Practice Address - Phone:408-262-1371
Practice Address - Fax:408-262-1371
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ008986111N00000X
CA30945111NR0400X, 111NS0005X
PADC009162111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV06353Medicare UPIN
PA094147Medicare ID - Type Unspecified