Provider Demographics
NPI:1699950030
Name:BATES, RYAN SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SHANE
Last Name:BATES
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 1:62 BRIARCHASE CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63367-6462
Mailing Address - Country:US
Mailing Address - Phone:314-496-1825
Mailing Address - Fax:
Practice Address - Street 1:4 WEST DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-0003
Practice Address - Country:US
Practice Address - Phone:636-536-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor