Provider Demographics
NPI:1750364709
Name:LYNCH, RYAN WARREN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WARREN
Last Name:LYNCH
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 1:2600 JAMES RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-3124
Mailing Address - Country:US
Mailing Address - Phone:817-326-1465
Mailing Address - Fax:817-326-1472
Practice Address - Street 1:2600 JAMES RD STE 400
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-3124
Practice Address - Country:US
Practice Address - Phone:817-326-1465
Practice Address - Fax:817-326-1472
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608130OtherBCBS PROVIDER ID
TXV04288Medicare UPIN
TX8D4075Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX608130OtherBCBS PROVIDER ID