Provider Demographics
NPI:1053365239
Name:EVERHART, RYAN E (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:E
Last Name:EVERHART
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:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-0135
Mailing Address - Country:US
Mailing Address - Phone:801-845-8156
Mailing Address - Fax:
Practice Address - Street 1:151 N STATE ST
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:UT
Practice Address - Zip Code:84050-9919
Practice Address - Country:US
Practice Address - Phone:801-845-8156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011203111N00000X
UT7443715-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11203-9BOtherWORKERS COMPENSATION
NYV00526Medicare UPIN
NYRB0361Medicare ID - Type Unspecified