Provider Demographics
NPI:1285793679
Name:RYAN MARSHALL PLLC
Entity type:Organization
Organization Name:RYAN MARSHALL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-494-0929
Mailing Address - Street 1:6703 EAST 81ST STREET
Mailing Address - Street 2:STE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4157
Mailing Address - Country:US
Mailing Address - Phone:918-494-0929
Mailing Address - Fax:918-494-0927
Practice Address - Street 1:6703 EAST 81ST STREET
Practice Address - Street 2:STE E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4157
Practice Address - Country:US
Practice Address - Phone:918-494-0929
Practice Address - Fax:918-494-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200069340AMedicaid
249504601Medicare PIN
OK200069340AMedicaid