Provider Demographics
NPI:1790713980
Name:RYAN, TIMOTHY PARKER (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PARKER
Last Name:RYAN
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 1:690 N MERIDIAN RD
Mailing Address - Street 2:STE 108
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3586
Mailing Address - Country:US
Mailing Address - Phone:406-755-6030
Mailing Address - Fax:406-755-6031
Practice Address - Street 1:690 N MERIDIAN RD
Practice Address - Street 2:STE 108
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3586
Practice Address - Country:US
Practice Address - Phone:406-755-6030
Practice Address - Fax:406-755-6031
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTU84372Medicare UPIN