Provider Demographics
NPI:1104576453
Name:TARRY, RYAN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:TARRY
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 1:13000 W 87TH STREET PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2879
Mailing Address - Country:US
Mailing Address - Phone:913-400-2014
Mailing Address - Fax:
Practice Address - Street 1:13000 W 87TH STREET PKWY STE 105
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2879
Practice Address - Country:US
Practice Address - Phone:913-400-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor