Provider Demographics
NPI:1780768507
Name:WEUM, RYAN KIMBERLY (DC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:KIMBERLY
Last Name:WEUM
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 1:1225 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3926
Mailing Address - Country:US
Mailing Address - Phone:218-847-9235
Mailing Address - Fax:218-847-9236
Practice Address - Street 1:1225 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3926
Practice Address - Country:US
Practice Address - Phone:218-847-9235
Practice Address - Fax:218-847-9236
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT66286Medicare UPIN