Provider Demographics
NPI:1912151234
Name:SHAKLEY, RYAN DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DALE
Last Name:SHAKLEY
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 1:185 HARRY S TRUMAN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7580
Mailing Address - Country:US
Mailing Address - Phone:210-263-4171
Mailing Address - Fax:410-263-4275
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7580
Practice Address - Country:US
Practice Address - Phone:410-263-4171
Practice Address - Fax:410-263-4275
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor