Provider Demographics
NPI:1760429732
Name:THOMAS, RYAN M (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 SE 172ND AVE
Mailing Address - Street 2:SUITE 166 BOX 280
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8737
Mailing Address - Country:US
Mailing Address - Phone:503-491-0388
Mailing Address - Fax:
Practice Address - Street 1:329 NE HOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7449
Practice Address - Country:US
Practice Address - Phone:503-491-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3110111NX0800X
CO4394111NX0800X
UT7912009-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202562300OtherU.S. DEPT OF LABOR
ORU67185Medicare UPIN
ORU67185Medicare UPIN