Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC11708 | TX |
N | 111NS0005X | Chiropractic Sports Physician | DC1594 | LA |
NPI | 1285932236 |
---|---|
Provider Name | Kelly Matthews Ryder |
First Address | Dallas, TX 75206-5209 |
Second Address | Dallas, TX 75206-5209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2011 |
Last Update Date | 07/04/2014 |