Healthcare Provider Details

I. General information

NPI: 1811920259
Provider Name (Legal Business Name): RYAN SPULLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 SANTA RITA RD SUITE 3
PLEASANTON CA
94566-4151
US

IV. Provider business mailing address

2340 SANTA RITA RD SUITE 3
PLEASANTON CA
94566-4151
US

V. Phone/Fax

Practice location:
  • Phone: 925-484-2558
  • Fax: 925-484-3951
Mailing address:
  • Phone: 925-484-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: