Healthcare Provider Details

I. General information

NPI: 1902000607
Provider Name (Legal Business Name): RYAN E STEVENS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 47TH PL
WESTWOOD KS
66205-1803
US

IV. Provider business mailing address

2000 W 47TH PL
WESTWOOD KS
66205-1803
US

V. Phone/Fax

Practice location:
  • Phone: 816-729-0947
  • Fax: 816-216-7177
Mailing address:
  • Phone: 816-729-0947
  • Fax: 816-216-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5024
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: