Provider Demographics
NPI:1386153666
Name:FESSEL, RYAN STEVEN (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:STEVEN
Last Name:FESSEL
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 1:1151 BADEN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2703
Mailing Address - Country:US
Mailing Address - Phone:760-505-1662
Mailing Address - Fax:
Practice Address - Street 1:519 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5176
Practice Address - Country:US
Practice Address - Phone:805-925-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty