Provider Demographics
NPI:1386966315
Name:WEED, RYAN BALLARD (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BALLARD
Last Name:WEED
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 1:13965 W CHINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1457
Mailing Address - Country:US
Mailing Address - Phone:208-266-7000
Mailing Address - Fax:
Practice Address - Street 1:3163 E FAIRVIEW AVE STE 155
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8102
Practice Address - Country:US
Practice Address - Phone:208-890-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor