Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHR.0007052 | CO |
NPI | 1346671179 |
---|---|
Provider Name | Dr. Ryan Lystad |
First Address | Denver, CO 80210-2204 |
Second Address | Denver, CO 80210-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 04/12/2013 |