Provider Demographics
NPI:1063877496
Name:ROWENHORST, RYAN GRANT (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GRANT
Last Name:ROWENHORST
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 1:77 ERIE VILLAGE SQ UNIT 150
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6995
Mailing Address - Country:US
Mailing Address - Phone:918-695-3307
Mailing Address - Fax:
Practice Address - Street 1:77 ERIE VILLAGE SQ UNIT 150
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6995
Practice Address - Country:US
Practice Address - Phone:918-695-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor