Provider Demographics
NPI:1194954966
Name:DAILEY, RYAN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DAILEY
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 1:30 SPRING MILL CT.
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1790
Mailing Address - Country:US
Mailing Address - Phone:317-831-3877
Mailing Address - Fax:317-831-4748
Practice Address - Street 1:30 SPRING MILL CT
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1790
Practice Address - Country:US
Practice Address - Phone:317-831-3877
Practice Address - Fax:317-831-4748
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002464A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor