Provider Demographics
NPI:1811913213
Name:HUMMEL, RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:HUMMEL
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 1:5055 N HARBOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2302
Mailing Address - Country:US
Mailing Address - Phone:619-523-9355
Mailing Address - Fax:
Practice Address - Street 1:5055 N HARBOR DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2302
Practice Address - Country:US
Practice Address - Phone:619-523-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602-612-519Medicare UPIN