MEDICARE: RYAN F BLOSSEY DC

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	DC24850	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0248500	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1174526230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN F BLOSSEY DC

Provider Business Mailing Address
First Line	:	5241 LAMPSON AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1953
Country	:	US
Telephone Number	:	714-379-3311
Fax Number	:	714-379-3313

Provider Business Practice Location Address
First Line	:	5241 LAMPSON AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1953
Country	:	US
Telephone Number	:	714-379-3311
Fax Number	:	714-379-3313

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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Directions to “ RYAN F BLOSSEY DC” Practice Location

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