Provider Demographics
NPI:1053963595
Name:BISHTON, RYAN JOSEPH (DC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JOSEPH
Last Name:BISHTON
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 1:9260 MAPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5651
Mailing Address - Country:US
Mailing Address - Phone:708-502-3615
Mailing Address - Fax:
Practice Address - Street 1:1480 N ORCHARD RD STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-7940
Practice Address - Country:US
Practice Address - Phone:630-313-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2021-05-25
Deactivation Date:2021-03-28
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
IL038.013380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor