Provider Demographics
NPI:1154568046
Name:GOETZ, RYAN DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DEAN
Last Name:GOETZ
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 1:204 LEWIS AVE S STE 203
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55388-4502
Mailing Address - Country:US
Mailing Address - Phone:952-955-1974
Mailing Address - Fax:952-955-3249
Practice Address - Street 1:204 LEWIS AVE S
Practice Address - Street 2:SUITE 203
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388-4500
Practice Address - Country:US
Practice Address - Phone:952-955-1974
Practice Address - Fax:952-955-3249
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor