Healthcare Provider Details

I. General information

NPI: 1003916610
Provider Name (Legal Business Name): RYAN T VANROO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MILTON AVE
JANESVILLE WI
53545-0441
US

IV. Provider business mailing address

2505 MILTON AVE
JANESVILLE WI
53545-0441
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-5225
  • Fax:
Mailing address:
  • Phone: 608-756-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3734-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: