Provider Demographics
NPI:1699305367
Name:POKRYWKA, RYAN S (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:POKRYWKA
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 1:725 N PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1151
Mailing Address - Country:US
Mailing Address - Phone:630-267-5433
Mailing Address - Fax:
Practice Address - Street 1:725 N PINECREST RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1151
Practice Address - Country:US
Practice Address - Phone:630-267-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor