Provider Demographics
NPI:1992719629
Name:DIEBOLD, RYAN M (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:DIEBOLD
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 1:9004 W 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80005-1586
Mailing Address - Country:US
Mailing Address - Phone:303-456-5710
Mailing Address - Fax:303-456-5760
Practice Address - Street 1:9004 W 88TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80005-1586
Practice Address - Country:US
Practice Address - Phone:303-456-5710
Practice Address - Fax:303-456-5760
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor