Provider Demographics
NPI:1285241836
Name:CASTRO, RYEN ROQUELLE (CH61098842)
Entity type:Individual
Prefix:DR
First Name:RYEN
Middle Name:ROQUELLE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CH61098842
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:344 CLEVELAND AVE SE STE D
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3342
Mailing Address - Country:US
Mailing Address - Phone:360-357-5170
Mailing Address - Fax:360-357-5173
Practice Address - Street 1:344 CLEVELAND AVE SE STE D
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3342
Practice Address - Country:US
Practice Address - Phone:360-357-5170
Practice Address - Fax:360-357-5173
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61098842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor