Provider Demographics
NPI:1912128471
Name:RYU, YONGKI COLIN (DC, MS, ICCSP, DGCSS)
Entity Type:Individual
Prefix:DR
First Name:YONGKI
Middle Name:COLIN
Last Name:RYU
Suffix:
Gender:M
Credentials:DC, MS, ICCSP, DGCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 PROSPECT AVE.
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1712
Mailing Address - Country:US
Mailing Address - Phone:201-313-0321
Mailing Address - Fax:
Practice Address - Street 1:633 PROSPECT AVE.
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1712
Practice Address - Country:US
Practice Address - Phone:201-313-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010717111NS0005X
IA06861111NS0005X
NY011408111NS0005X
CT001720111NS0005X
NJ38MC00659900111NS0005X
NYX-011408-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
244164Medicare PIN