Healthcare Provider Details

I. General information

NPI: 1588791941
Provider Name (Legal Business Name): RYAN CHRISTOPHER WEBER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 ADAMSON SQ
CARROLLTON GA
30117-3213
US

IV. Provider business mailing address

307 ADAMSON SQ
CARROLLTON GA
30117-3213
US

V. Phone/Fax

Practice location:
  • Phone: 770-214-9146
  • Fax: 770-214-9166
Mailing address:
  • Phone: 770-214-9146
  • Fax: 770-214-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR007565
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: