Healthcare Provider Details

I. General information

NPI: 1376695486
Provider Name (Legal Business Name): STEVEN T RYAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 SE PETROVITSKY RD STE 109
RENTON WA
98058-8900
US

IV. Provider business mailing address

14410 SE PETROVITSKY RD STE 109
RENTON WA
98058-8900
US

V. Phone/Fax

Practice location:
  • Phone: 425-226-1856
  • Fax: 425-226-0231
Mailing address:
  • Phone: 425-226-1856
  • Fax: 425-226-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: