MEDICARE: RYAN GRENIER LLC

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

General Provider Information

NPI Number	:	1518513043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN GRENIER LLC

Provider Business Mailing Address
First Line	:	3017 N CYPRESS DRIVE
Second Line	:	SUITE B
City	:	WICHITA
State	:	KS
Zip	:	67226-4026
Country	:	US
Telephone Number	:	316-425-1911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 N CYPRESS ST STE B
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-4026
Country	:	US
Telephone Number	:	316-425-1911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RYAN C GRENIER
Credential	:	DC
Telephone Number	:	316-371-5623

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	05/14/2020

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