Provider Demographics
NPI:1053388314
Name:ATKINSON, RYAN ALLEN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ALLEN
Last Name:ATKINSON
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 1:2179 W 1800 N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7900
Mailing Address - Country:US
Mailing Address - Phone:801-614-0166
Mailing Address - Fax:801-614-0167
Practice Address - Street 1:2179 W 1800 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-7900
Practice Address - Country:US
Practice Address - Phone:801-614-0166
Practice Address - Fax:801-614-0167
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5188221-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056330Medicare ID - Type UnspecifiedMEDICARE