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General NPI Number Information
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NPI Number | 1902813074
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Entity Type | Individual
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Provider Name | RYAN WALTON WADE DC
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 5341 S SUPERSTITION MOUNTAIN DR SUITE D101
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2069
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Country | US
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Telephone | 480-983-2249
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Fax | 480-983-1541
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Provider Business Mailing Address
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Address Line | 5341 S SUPERSTITION MOUNTAIN DR STE D101
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City | GOLD CANYON
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State | AZ
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Zip | 85118-2069
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Country | US
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Telephone | 480-983-2249
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Fax | 480-983-1541
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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 | 7113
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License Number State | AZ
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