NPIMap

Organization Active NPI

Ryan Chiropractic PLLC

  • Chiropractor
  • Waterloo, NY
National Provider Identifier
1528134178
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X0054062 Issued in NY
Legal business name
RYAN CHIROPRACTIC PLLC
Practice address
2374 Mound Rd Rte 414
Waterloo, NY 13165
Phone
(315) 539-3262
Fax
(315) 539-5221
NPI assigned
Nov 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul W Ryan, DCNPI 1992725295
Title
Chiropractor
Phone
(315) 539-3262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X X0054062 NY Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X X0061021 NY
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X X010083 NY

Addresses

Primary practice location

2374 Mound Rd Rte 414
Waterloo, NY 13165

Mailing address

PO Box 664
Waterloo, NY 13165
Phone (315) 539-3262

Other identifiers 4

IdentifierTypeStateIssuer
5211586OtherAETNA
7153201OtherAETNA
101869ANOtherPREFERRED CARE
101865ANOtherPREFERRED CARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080129000448 NY Part B Supplier - Clinic/Group Practice 1254413388 Receives reassigned benefits from 3 practitioners
Practice locations: Seneca Falls, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1528134178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 664",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "13165",
            "telephone_number": "315-539-3262",
            "fax_number": "315-539-5221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2374 MOUND RD RTE 414",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "13165",
            "telephone_number": "315-539-3262",
            "fax_number": "315-539-5221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RYAN CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "315-539-3262",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X0054062",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X0061021",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X010083",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5211586",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7153201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "101869AN",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "101865AN",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.