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General NPI Number Information
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NPI Number | 1780080879
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Entity Type | Organization
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Legal Business Name | RYNO FAMILY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 10204 W HAPPY VALLEY RD STE 135
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City | PEORIA
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State | AZ
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Zip | 85383-2880
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Country | US
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Telephone | 623-335-2471
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Fax |
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Provider Business Mailing Address
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Address Line | 22026 N 103RD LN LOT 358
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City | PEORIA
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State | AZ
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Zip | 85383-2681
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Country | US
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Telephone | 623-695-3173
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN WILK
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Credential | D.C.
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Telephone | 623-695-3173
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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 | 8388
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License Number State | AZ
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