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General NPI Number Information
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NPI Number | 1841470168
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Entity Type | Organization
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Legal Business Name | DR. RYAN MAYNARD CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 81 HAGER BR RD
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City | EAST POINT
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State | KY
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Zip | 41216
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Country | US
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Telephone | 606-886-3737
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Fax | 606-886-3722
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Provider Business Mailing Address
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Address Line | PO BOX 1774
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City | PRESTONSBURG
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State | KY
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Zip | 41653-5774
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Country | US
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Telephone | 606-886-3737
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Fax | 606-886-3722
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER RYAN MAYNARD
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Credential | D.C.
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Telephone | 606-886-3737
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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 | 4712
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License Number State | KY
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