Provider Demographics
NPI:1194265504
Name:BAKOSH, RYAN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BAKOSH
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 1:65 N RIVER LN
Mailing Address - Street 2:STE 207
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4519
Mailing Address - Country:US
Mailing Address - Phone:630-492-0490
Mailing Address - Fax:
Practice Address - Street 1:65 N RIVER LN
Practice Address - Street 2:STE 207
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4519
Practice Address - Country:US
Practice Address - Phone:630-492-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor