Provider Demographics
NPI:1841652161
Name:BAACK, RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BAACK
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 1:1421 S POTOMAC ST STE 330
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4512
Mailing Address - Country:US
Mailing Address - Phone:303-953-2920
Mailing Address - Fax:303-997-5225
Practice Address - Street 1:1421 S POTOMAC ST STE 330
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4512
Practice Address - Country:US
Practice Address - Phone:303-953-2920
Practice Address - Fax:303-997-5225
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007425111N00000X
COCHR.0007425111NR0400X, 111NS0005X, 225000000X, 225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR.0007425OtherLICENSE