Provider Demographics
NPI:1710662846
Name:TULON, RYAN ANDREW (LAC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:TULON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:TULON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2435 KIMBERLY RD STE 290
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3509
Mailing Address - Country:US
Mailing Address - Phone:512-969-8578
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD STE 290
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:512-969-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-123171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist