=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003095456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYCKMAN CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2007
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5154 MILLER RD SUITE J
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-733-0310
-----------------------------------------------------
Fax | 810-733-5554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5154 MILLER RD SUITE J
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-733-0310
-----------------------------------------------------
Fax | 810-733-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM DEAN RYCKMAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 810-733-0310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------