Provider Demographics
NPI:1962104711
Name:RAYMOND, RYAN COLE (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:COLE
Last Name:RAYMOND
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 1:1116 COLDWATER DR
Mailing Address - Street 2:
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93225-9608
Mailing Address - Country:US
Mailing Address - Phone:661-472-1168
Mailing Address - Fax:
Practice Address - Street 1:20280 SW ACACIA ST STE 120
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0782
Practice Address - Country:US
Practice Address - Phone:949-723-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor