Provider Demographics
NPI:1760240485
Name:SHOOK, RYAN E (DC, LMT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:E
Last Name:SHOOK
Suffix:
Gender:M
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50639 LICKSKILLET RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45772-9746
Mailing Address - Country:US
Mailing Address - Phone:740-262-2957
Mailing Address - Fax:
Practice Address - Street 1:903 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2361
Practice Address - Country:US
Practice Address - Phone:740-262-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022085225700000X
OHDC-05107111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist