Provider Demographics
NPI:1508440538
Name:EGGERT, RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:EGGERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 FAIRFIELD AVE S UNIT A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1700
Mailing Address - Country:US
Mailing Address - Phone:727-475-1463
Mailing Address - Fax:
Practice Address - Street 1:3430 FAIRFIELD AVE S UNIT A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1700
Practice Address - Country:US
Practice Address - Phone:727-475-1463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor