Provider Demographics
NPI:1700183563
Name:NOGLE, RYAN MAURICE (DC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MAURICE
Last Name:NOGLE
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 1:731 NE LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1353
Mailing Address - Country:US
Mailing Address - Phone:816-373-3373
Mailing Address - Fax:816-373-2902
Practice Address - Street 1:10707 E WINNER RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-3759
Practice Address - Country:US
Practice Address - Phone:816-350-1100
Practice Address - Fax:816-252-5400
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor