Provider Demographics
NPI:1316464522
Name:ANSON, RYAN N (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:N
Last Name:ANSON
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 1:2504 E 14TH PL STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4607
Mailing Address - Country:US
Mailing Address - Phone:918-720-5989
Mailing Address - Fax:
Practice Address - Street 1:2504 E 14TH PL STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4607
Practice Address - Country:US
Practice Address - Phone:918-720-5989
Practice Address - Fax:918-518-7006
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor