Provider Demographics
NPI:1811920259
Name:SPULLER, RYAN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SPULLER
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 1:2340 SANTA RITA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4151
Mailing Address - Country:US
Mailing Address - Phone:925-484-2558
Mailing Address - Fax:
Practice Address - Street 1:2340 SANTA RITA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4151
Practice Address - Country:US
Practice Address - Phone:925-484-2558
Practice Address - Fax:925-484-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor