MEDICARE: DR. RYAN COLE BREWER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7695	AZ

General Provider Information

NPI Number	:	1508931528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN COLE BREWER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 2578
Second Line	:	1200 W CLEVELAND #6
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-2578
Country	:	US
Telephone Number	:	928-337-3125
Fax Number	:	928-337-3291

Provider Business Practice Location Address
First Line	:	1200 W CLEVELAND
Second Line	:	SUITE 6
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-2578
Country	:	US
Telephone Number	:	928-337-3125
Fax Number	:	928-337-3291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/14/2011

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