Provider Demographics
NPI:1750881710
Name:MULLEN, RYAN ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANTHONY
Last Name:MULLEN
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 1:418 S KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1553
Mailing Address - Country:US
Mailing Address - Phone:570-886-0385
Mailing Address - Fax:
Practice Address - Street 1:418 S KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1553
Practice Address - Country:US
Practice Address - Phone:570-886-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ010973111N00000X
PADC011215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty