=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215230388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN D. MONSON, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2010
-----------------------------------------------------
Last Update Date | 12/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 N 8TH ST SUITE 1
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72756-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-621-9006
-----------------------------------------------------
Fax | 479-621-9497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 N 8TH ST SUITE 1
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72756-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-621-9006
-----------------------------------------------------
Fax | 479-621-9497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CHAIRMAN
-----------------------------------------------------
Name | DR. RYAN D. MONSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 479-621-9006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 1401
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------