Provider Demographics
NPI:1699957753
Name:RYAN H. HOLMES, D.C., P.C.
Entity type:Organization
Organization Name:RYAN H. HOLMES, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-232-8377
Mailing Address - Street 1:3302 S BELT HWY
Mailing Address - Street 2:STE. G
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1561
Mailing Address - Country:US
Mailing Address - Phone:816-232-8377
Mailing Address - Fax:816-232-8699
Practice Address - Street 1:3302 S BELT HWY
Practice Address - Street 2:STE. G
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1561
Practice Address - Country:US
Practice Address - Phone:816-232-8377
Practice Address - Fax:816-232-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004008727Medicare PIN