Healthcare Provider Details

I. General information

NPI: 1730476755
Provider Name (Legal Business Name): RYAN MICHAEL KILLARNEY L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S 500 E STE 202
SALT LAKE CITY UT
84102-1094
US

IV. Provider business mailing address

34 S 500 E STE 202
SALT LAKE CITY UT
84102-1094
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-2011
  • Fax:
Mailing address:
  • Phone: 801-582-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9189496-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: