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General NPI Number Information
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NPI Number | 1902810666
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Entity Type | Organization
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Legal Business Name | DR. IRENE M RYAN
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1649 E PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1121
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Country | US
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Telephone | 215-465-3400
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Fax | 215-465-3809
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Provider Business Mailing Address
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Address Line | 1649 E PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1121
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Country | US
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Telephone | 215-465-3400
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Fax | 215-465-3809
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. IRENE M RYAN
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Credential | D.C.
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Telephone | 215-465-3400
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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 | DC 002108 L
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License Number State | PA
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