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General NPI Number Information
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NPI Number | 1659437309
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Entity Type | Organization
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Legal Business Name | MATTHEW W. RYAN, DC PC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 206 E MAY ST
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City | WINDER
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State | GA
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Zip | 30680-7127
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Country | US
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Telephone | 770-867-2225
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Fax | 770-867-7161
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Provider Business Mailing Address
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Address Line | PO BOX 491
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City | WINDER
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State | GA
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Zip | 30680-0491
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Country | US
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Telephone | 770-867-2225
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Fax | 770-867-7161
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW WALTER RYAN
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Credential | DC
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Telephone | 770-867-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR005174
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License Number State | GA
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