Provider Demographics
NPI:1881162600
Name:AVERETT, RYAN CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:AVERETT
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 1:17 N MERCHANT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1601
Mailing Address - Country:US
Mailing Address - Phone:801-855-6101
Mailing Address - Fax:801-980-0510
Practice Address - Street 1:17 N MERCHANT ST STE 3
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1601
Practice Address - Country:US
Practice Address - Phone:801-855-6101
Practice Address - Fax:801-980-0510
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7102980-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor