Provider Demographics
NPI:1477560167
Name:MARSHALL, RYAN DANE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DANE
Last Name:MARSHALL
Suffix:
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 1:6703 EAST 81ST STREET
Mailing Address - Street 2:STE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4153
Mailing Address - Country:US
Mailing Address - Phone:918-494-0929
Mailing Address - Fax:918-494-0927
Practice Address - Street 1:6703 EAST 81ST STREET
Practice Address - Street 2:STE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4157
Practice Address - Country:US
Practice Address - Phone:918-494-0929
Practice Address - Fax:918-494-0927
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200069340AMedicaid
OK249504601Medicare ID - Type Unspecified