Provider Demographics
NPI:1720199516
Name:HANSON, RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:HANSON
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 1:1717 S BOULEVARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5175
Mailing Address - Country:US
Mailing Address - Phone:405-341-0494
Mailing Address - Fax:405-341-8718
Practice Address - Street 1:1717 S BOULEVARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5175
Practice Address - Country:US
Practice Address - Phone:405-341-0494
Practice Address - Fax:405-341-8718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor