Healthcare Provider Details

I. General information

NPI: 1093051815
Provider Name (Legal Business Name): ANDREW RYAN CANAVAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2128
US

IV. Provider business mailing address

984 ROCKLEDGE BLVD
ROCKLEDGE FL
32955-2128
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-6090
  • Fax: 321-632-5805
Mailing address:
  • Phone: 321-636-6090
  • Fax: 321-632-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: