Healthcare Provider Details

I. General information

NPI: 1124674171
Provider Name (Legal Business Name): RYKEN-NDFC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 532
GILBERT AZ
85295-3210
US

IV. Provider business mailing address

1760 E PECOS RD STE 532
GILBERT AZ
85295-3210
US

V. Phone/Fax

Practice location:
  • Phone: 480-590-1380
  • Fax: 480-857-2036
Mailing address:
  • Phone: 480-590-1380
  • Fax: 480-857-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN HICKS
Title or Position: DR OF CHIROPRACTIC/OWNER
Credential: DC
Phone: 480-857-1991