MEDICARE: RYAN DUKE 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	4617	SC

General Provider Information

NPI Number	:	1255929816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DUKE D.C.

Provider Business Mailing Address
First Line	:	907 HOUSTON NORTHCUTT BLVD
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3448
Country	:	US
Telephone Number	:	843-856-0351
Fax Number	:	843-856-0354

Provider Business Practice Location Address
First Line	:	907 HOUSTON NORTHCUTT BLVD
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3448
Country	:	US
Telephone Number	:	843-856-0351
Fax Number	:	843-856-0354

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

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	12/05/2022

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Directions to “ RYAN DUKE D.C.” Practice Location

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