Provider Demographics
NPI:1174753230
Name:MARSHALL, RYAN (MATCM, LAC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MATCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4101
Mailing Address - Country:US
Mailing Address - Phone:907-441-4154
Mailing Address - Fax:
Practice Address - Street 1:2008 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4101
Practice Address - Country:US
Practice Address - Phone:907-441-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist