MEDICARE: DR. RYAN MICHAEL FAULKNER 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	2013018389	MO

General Provider Information

NPI Number	:	1881020006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MICHAEL FAULKNER D.C.

Provider Business Mailing Address
First Line	:	8 SHIPLEY CT
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3024
Country	:	US
Telephone Number	:	314-330-0626
Fax Number	:

Provider Business Practice Location Address
First Line	:	6251 RONALD REAGAN DR
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-2665
Country	:	US
Telephone Number	:	636-614-2139
Fax Number	:

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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