Provider Demographics
NPI:1306968557
Name:HEID, RYAN MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:HEID
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 1:1500 HUGUENOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2478
Mailing Address - Country:US
Mailing Address - Phone:804-608-3045
Mailing Address - Fax:804-767-3565
Practice Address - Street 1:1500 HUGUENOT RD STE 101
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2478
Practice Address - Country:US
Practice Address - Phone:804-608-3045
Practice Address - Fax:804-767-3565
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor