MEDICARE: RYAN MAURICE NOGLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2011002864	MO

General Provider Information

NPI Number	:	1700183563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MAURICE NOGLE D.C.

Provider Business Mailing Address
First Line	:	731 NE LAKEWOOD BLVD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-1353
Country	:	US
Telephone Number	:	816-373-3373
Fax Number	:	816-373-2902

Provider Business Practice Location Address
First Line	:	10707 E WINNER RD
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64052-3759
Country	:	US
Telephone Number	:	816-350-1100
Fax Number	:	816-252-5400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	05/27/2021

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