Provider Demographics
NPI:1053516807
Name:RYAN CHIROPRACTIC CLINIC PLLC
Entity type:Organization
Organization Name:RYAN CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-755-6030
Mailing Address - Street 1:690 N MERIDIAN RD
Mailing Address - Street 2:STE 108
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3586
Mailing Address - Country:US
Mailing Address - Phone:406-755-6030
Mailing Address - Fax:
Practice Address - Street 1:690 N MERIDIAN RD
Practice Address - Street 2:STE 108
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3586
Practice Address - Country:US
Practice Address - Phone:406-755-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center