MEDICARE: DR. RYAN GRANT ROWENHORST D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHR.0007334	CO

General Provider Information

NPI Number	:	1063877496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN GRANT ROWENHORST D.C.

Provider Business Mailing Address
First Line	:	77 ERIE VILLAGE SQ UNIT 150
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-6995
Country	:	US
Telephone Number	:	918-695-3307
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 ERIE VILLAGE SQ UNIT 150
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-6995
Country	:	US
Telephone Number	:	918-695-3307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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