Provider Demographics
NPI:1881774792
Name:RYAN, PATRICK TRENT (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:TRENT
Last Name:RYAN
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 1:6 SHARPLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2941
Mailing Address - Country:US
Mailing Address - Phone:302-778-0100
Mailing Address - Fax:302-652-1116
Practice Address - Street 1:6 SHARPLEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2941
Practice Address - Country:US
Practice Address - Phone:302-778-0100
Practice Address - Fax:302-652-1116
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000443111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000516521OtherAETNA
DE2053546000OtherAMERIHEALTH
DE6469570001OtherPTAN
DE510381CHIOtherBLUE CROSS
DE2255615000OtherKEYSTONE
DE2255615000OtherKEYSTONE