1114036159 NPI number — DR. RYAN M ROCK D.C.

Table of content: DR. RYAN M ROCK D.C. (NPI 1114036159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114036159 NPI number — DR. RYAN M ROCK D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCK
Provider First Name:
RYAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114036159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUDORA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66025-0706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-542-2118
Provider Business Mailing Address Fax Number:
785-542-1164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 CHURCH ST
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
EUDORA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66025-9489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-542-2118
Provider Business Practice Location Address Fax Number:
785-542-1164
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-04835 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00290537 . This is a "RRMC PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 11319888 . This is a "CAQH PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 35886021 . This is a "BCBSKC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2195757 . This is a "FIRST HEALTH PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 665384 . This is a "UNITED PROVIDER NUMBER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 282759 . This is a "COVENTRY PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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