Provider Demographics
NPI:1841470168
Name:DR. RYAN MAYNARD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DR. RYAN MAYNARD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-886-3737
Mailing Address - Street 1:PO BOX 1774
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-5774
Mailing Address - Country:US
Mailing Address - Phone:606-886-3737
Mailing Address - Fax:606-886-3722
Practice Address - Street 1:81 HAGER BR RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:KY
Practice Address - Zip Code:41216
Practice Address - Country:US
Practice Address - Phone:606-886-3737
Practice Address - Fax:606-886-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000252597OtherBCBS
KY85002400Medicaid
KY0745101Medicare PIN