MEDICARE: DR. RYAN THOMAS DUROCHER 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	038-009110	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00331729	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08432102	OTHER	IL	BCBS
3	666373	OTHER	IL	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1871593350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN THOMAS DUROCHER D.C.

Provider Business Mailing Address
First Line	:	3608 CARNOUSTIE DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-5555
Country	:	US
Telephone Number	:	217-622-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3608 CARNOUSTIE DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-5555
Country	:	US
Telephone Number	:	217-622-6161
Fax Number	:

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	11/16/2022

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