Provider Demographics
NPI:1699166298
Name:ROWELL, RYAN JAMES (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:ROWELL
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 1:2200 E 4500 S STE 110
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4033
Mailing Address - Country:US
Mailing Address - Phone:801-272-8500
Mailing Address - Fax:
Practice Address - Street 1:2200 E 4500 S STE 110
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4033
Practice Address - Country:US
Practice Address - Phone:801-272-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9246735-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor