MEDICARE: DR. OLVA EARL RYAN 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	2257	TX

General Provider Information

NPI Number	:	1811090012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLVA EARL RYAN DC

Provider Business Mailing Address
First Line	:	1906 S COLLEGE AVE
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-1417
Country	:	US
Telephone Number	:	979-822-7006
Fax Number	:	979-822-7006

Provider Business Practice Location Address
First Line	:	1906 S COLLEGE AVE
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-1417
Country	:	US
Telephone Number	:	979-222-7006
Fax Number	:	979-822-7006

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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