Provider Demographics
NPI:1619329075
Name:LOREN, RYAN ADAM SR (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ADAM
Last Name:LOREN
Suffix:SR
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 1:12086 FORT CAROLINE RD
Mailing Address - Street 2:STE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7639
Mailing Address - Country:US
Mailing Address - Phone:904-902-4325
Mailing Address - Fax:
Practice Address - Street 1:12086 FORT CAROLINE RD
Practice Address - Street 2:STE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7639
Practice Address - Country:US
Practice Address - Phone:407-532-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor