Provider Demographics
NPI:1285704908
Name:MCGRAW, RYAN R (DC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:R
Last Name:MCGRAW
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:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-0181
Mailing Address - Country:US
Mailing Address - Phone:570-629-7900
Mailing Address - Fax:570-629-7968
Practice Address - Street 1:RT 611
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372
Practice Address - Country:US
Practice Address - Phone:570-629-7900
Practice Address - Fax:570-629-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007756L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001960620Medicaid
PA069802Medicare ID - Type Unspecified
PA001960620Medicaid