Healthcare Provider Details

I. General information

NPI: 1922932425
Provider Name (Legal Business Name): RYAN TANNER JOLLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 MAIN ST STE 200
THE COLONY TX
75056-3498
US

IV. Provider business mailing address

7204 MAIN ST STE 200
THE COLONY TX
75056-3498
US

V. Phone/Fax

Practice location:
  • Phone: 469-535-3800
  • Fax: 469-535-0399
Mailing address:
  • Phone: 469-535-3800
  • Fax: 469-533-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15971
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: