Provider Demographics
NPI:1730347071
Name:BELLACOV, RYAN LAMBERT (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LAMBERT
Last Name:BELLACOV
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:GENE
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:511 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2718
Mailing Address - Country:US
Mailing Address - Phone:503-351-8427
Mailing Address - Fax:503-579-4727
Practice Address - Street 1:5640 HOOD ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3224
Practice Address - Country:US
Practice Address - Phone:503-351-8427
Practice Address - Fax:503-351-8427
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3857111N00000X
OR0111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician