Provider Demographics
NPI:1316336803
Name:NOLTE, RYAN W (DC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:W
Last Name:NOLTE
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 1:1150 MONTREAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2393
Mailing Address - Country:US
Mailing Address - Phone:651-293-1497
Mailing Address - Fax:763-717-2988
Practice Address - Street 1:1150 MONTREAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116
Practice Address - Country:US
Practice Address - Phone:651-293-1497
Practice Address - Fax:763-717-2988
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor