MEDICARE: IRENE M RYAN 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	MC00191400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0116918000	OTHER	NJ	AMERIHEALTH
2	RY542916	OTHER	NJ	HORIZON

General Provider Information

NPI Number	:	1700823770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE M RYAN D.C.

Provider Business Mailing Address
First Line	:	25 N ALBANY AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-3569
Country	:	US
Telephone Number	:	609-345-3686
Fax Number	:	609-345-3698

Provider Business Practice Location Address
First Line	:	25 N ALBANY AVE
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-3569
Country	:	US
Telephone Number	:	609-345-3686
Fax Number	:	609-345-3698

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	06/25/2008

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Directions to “ IRENE M RYAN D.C.” Practice Location

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