Healthcare Provider Details

I. General information

NPI: 1114036159
Provider Name (Legal Business Name): RYAN M ROCK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 CHURCH ST STE E
EUDORA KS
66025-9489
US

IV. Provider business mailing address

PO BOX 706
EUDORA KS
66025-0706
US

V. Phone/Fax

Practice location:
  • Phone: 785-542-2118
  • Fax: 785-542-1164
Mailing address:
  • Phone: 785-542-2118
  • Fax: 785-542-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-04835
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: