Provider Demographics
NPI:1992725295
Name:RYAN, PAUL W (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:RYAN
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:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-0664
Mailing Address - Country:US
Mailing Address - Phone:315-539-3262
Mailing Address - Fax:315-539-5221
Practice Address - Street 1:2374 MOUND RD
Practice Address - Street 2:RTE 414
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165
Practice Address - Country:US
Practice Address - Phone:315-539-3262
Practice Address - Fax:315-539-5221
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006102-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
101869ANOtherPREFERRED CARE
NY14552CMedicare PIN
NYU12223Medicare UPIN