Healthcare Provider Details

I. General information

NPI: 1518185610
Provider Name (Legal Business Name): RYDER-HOLT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 132ND ST SE #C101
EVERETT WA
98208
US

IV. Provider business mailing address

4809 132ND ST SE #C101
EVERETT WA
98208
US

V. Phone/Fax

Practice location:
  • Phone: 425-585-0507
  • Fax: 425-948-7947
Mailing address:
  • Phone: 425-585-0507
  • Fax: 425-948-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00034253
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH00034253
License Number StateWA

VIII. Authorized Official

Name: MS. TRACEY A RYDER
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 425-585-0507