Healthcare Provider Details

I. General information

NPI: 1235778713
Provider Name (Legal Business Name): RYAN FUNKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2283 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1819
US

IV. Provider business mailing address

8311 N HIGH ST
COLUMBUS OH
43235-6459
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-2222
  • Fax: 866-907-6157
Mailing address:
  • Phone: 614-888-9355
  • Fax: 614-888-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number013333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: