Healthcare Provider Details

I. General information

NPI: 1629020656
Provider Name (Legal Business Name): RYAN MICHAEL KONARIK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15010 FM 2100 RD SUITE 112
CROSBY TX
77532-8119
US

IV. Provider business mailing address

15010 FM 2100 RD SUITE 112
CROSBY TX
77532-8119
US

V. Phone/Fax

Practice location:
  • Phone: 281-462-2500
  • Fax: 281-462-2544
Mailing address:
  • Phone: 281-462-2500
  • Fax: 281-462-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: