Provider Demographics
NPI:1598060758
Name:CAMPBELL, RYAN MACKENZIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MACKENZIE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 S AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3924
Mailing Address - Country:US
Mailing Address - Phone:614-738-8256
Mailing Address - Fax:
Practice Address - Street 1:3256 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3305
Practice Address - Country:US
Practice Address - Phone:206-939-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152900171100000X
OR1792175F00000X
WAAC60172844171100000X
WANT60181111175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist