Provider Demographics
NPI:1760595763
Name:WORRELL, RYAN MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:WORRELL
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 1:1409 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1845
Mailing Address - Country:US
Mailing Address - Phone:402-944-3333
Mailing Address - Fax:402-521-2085
Practice Address - Street 1:1409 SILVER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1845
Practice Address - Country:US
Practice Address - Phone:402-944-3333
Practice Address - Fax:402-521-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00005047OtherRAILROAD MEDICARE
NE10025113700Medicaid
NE239762OtherMIDLANDS CHOICE
113665512OtherTAX IDENTIFICATION
NE09547OtherBCBS
113665512OtherTAX IDENTIFICATION
276531Medicare ID - Type Unspecified