MEDICARE: DR. RYAN P RADEMACKER 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	X010717-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	838800	OTHER	NY	MANANGED PHYICAL NETWORK

General Provider Information

NPI Number	:	1659468551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN P RADEMACKER D.C.

Provider Business Mailing Address
First Line	:	23 NORTH ST
Second Line	:	SUITE 7
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1053
Country	:	US
Telephone Number	:	585-394-8430
Fax Number	:	585-394-8154

Provider Business Practice Location Address
First Line	:	23 NORTH ST
Second Line	:	SUITE 7
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1053
Country	:	US
Telephone Number	:	585-394-8430
Fax Number	:	585-394-8154

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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