Healthcare Provider Details

I. General information

NPI: 1760429732
Provider Name (Legal Business Name): RYAN M THOMAS DC, FACO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 NE HOOD AVE
GRESHAM OR
97030-7449
US

IV. Provider business mailing address

13203 SE 172ND AVE SUITE 166 BOX 280
HAPPY VALLEY OR
97086-8737
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-0388
  • Fax:
Mailing address:
  • Phone: 503-491-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number27-3110
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number4394
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number7912009-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: