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NPI Code Detail

MEDICARE: DR. RYAN KOOLEN D.C.

MEDICARE: DR. RYAN KOOLEN 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
1111N00000XChiropractor2301007736MI

General Provider Information

NPI Number : 1588627657
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN KOOLEN D.C.
Provider Business Mailing Address
First Line : 9751 E GRAND RIVER AVE
Second Line : PO BOX 367
City : PORTLAND
State : MI
Zip : 48875-9774
Country : US
Telephone Number : 517-647-5770
Fax Number : 517-647-5773
Provider Business Practice Location Address
First Line : 9751 E GRAND RIVER AVE
Second Line :
City : PORTLAND
State : MI
Zip : 48875-9774
Country : US
Telephone Number : 517-647-5770
Fax Number : 517-647-5773
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2006
Last Update Date : 09/07/2012

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Directions to “ DR. RYAN KOOLEN D.C.” Practice Location

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