Provider Demographics
NPI:1831273903
Name:RYAN, TIMOTHY J (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:RYAN
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 1:3330 COBB PKWY NW
Mailing Address - Street 2:SUITE 332
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8320
Mailing Address - Country:US
Mailing Address - Phone:678-664-4028
Mailing Address - Fax:678-792-8967
Practice Address - Street 1:3330 COBB PKWY NW
Practice Address - Street 2:SUITE 332
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8320
Practice Address - Country:US
Practice Address - Phone:678-664-4028
Practice Address - Fax:678-792-8967
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor