Provider Demographics
NPI:1215980149
Name:RYAN OVERTON D.C P.C.
Entity type:Organization
Organization Name:RYAN OVERTON D.C P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-660-0777
Mailing Address - Street 1:5224 15TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5791
Mailing Address - Country:US
Mailing Address - Phone:706-660-0777
Mailing Address - Fax:706-660-0805
Practice Address - Street 1:5224 15TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5791
Practice Address - Country:US
Practice Address - Phone:706-660-0777
Practice Address - Fax:706-660-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6497111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4638Medicare ID - Type UnspecifiedMEDICARE GROUP #