Provider Demographics
NPI:1902813074
Name:WADE, RYAN WALTON (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WALTON
Last Name:WADE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5341 S SUPERSTITION MOUNTAIN DR
Mailing Address - Street 2:STE D101
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-2069
Mailing Address - Country:US
Mailing Address - Phone:480-983-2249
Mailing Address - Fax:480-983-1541
Practice Address - Street 1:5341 S SUPERSTITION MOUNTAIN DR
Practice Address - Street 2:SUITE D101
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-2069
Practice Address - Country:US
Practice Address - Phone:480-983-2249
Practice Address - Fax:480-983-1541
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor