Provider Demographics
NPI:1780064535
Name:THOMAS, RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:THOMAS
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 1:1124 IVY LN
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-2434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2130 FREEPORT RD., FL. 2, STE B
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1542
Practice Address - Country:US
Practice Address - Phone:724-994-8587
Practice Address - Fax:724-909-1707
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA439157Medicare PIN