Provider Demographics
NPI:1548547086
Name:STICE, RYAN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:STICE
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 1:311 E UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1519
Mailing Address - Country:US
Mailing Address - Phone:618-210-0483
Mailing Address - Fax:
Practice Address - Street 1:311 E UNION AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1519
Practice Address - Country:US
Practice Address - Phone:618-210-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor