Provider Demographics
NPI:1871593350
Name:DUROCHER, RYAN THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:DUROCHER
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 1:3608 CARNOUSTIE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-5555
Mailing Address - Country:US
Mailing Address - Phone:217-622-6161
Mailing Address - Fax:
Practice Address - Street 1:3608 CARNOUSTIE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62712-5555
Practice Address - Country:US
Practice Address - Phone:217-622-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08432102OtherBCBS
ILP00331729OtherRAILROAD MEDICARE
IL666373OtherUNITED HEALTHCARE
IL08432102OtherBCBS
ILK07997Medicare UPIN