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General NPI Number Information
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NPI Number | 1740647049
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Entity Type | Individual
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Provider Name | RYAN JOSHUA DESANTIS D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 982 N TYLER RD STE D
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City | WICHITA
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State | KS
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Zip | 67212-3271
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Country | US
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Telephone | 316-201-6379
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 N PENSTEMON CT
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City | WICHITA
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State | KS
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Zip | 67226-1812
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Country | US
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Telephone | 903-985-0397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 01-05782
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License Number State | KS
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