Provider Demographics
NPI:1053019455
Name:RYAN DAVID MARTIN
Entity type:Organization
Organization Name:RYAN DAVID MARTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-488-5665
Mailing Address - Street 1:PO BOX 3039
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-5039
Mailing Address - Country:US
Mailing Address - Phone:503-488-5665
Mailing Address - Fax:
Practice Address - Street 1:308 N VILLA RD STE 116
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1881
Practice Address - Country:US
Practice Address - Phone:503-488-5665
Practice Address - Fax:503-893-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty