Provider Demographics
NPI:1053542266
Name:RYAN FORD DC LLC
Entity type:Organization
Organization Name:RYAN FORD DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-623-8187
Mailing Address - Street 1:1901 E 32ND ST STE 5
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3071
Mailing Address - Country:US
Mailing Address - Phone:417-623-8187
Mailing Address - Fax:417-623-9011
Practice Address - Street 1:1901 E 32ND ST STE 5
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3071
Practice Address - Country:US
Practice Address - Phone:417-623-8187
Practice Address - Fax:417-623-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center