Provider Demographics
NPI:1053872069
Name:SHEPHERD, RYAN (ND, LAC, RAC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:ND, LAC, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 KESTREL DR # A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7566
Mailing Address - Country:US
Mailing Address - Phone:512-596-9616
Mailing Address - Fax:
Practice Address - Street 1:100 COMMONS RD STE 1
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3966
Practice Address - Country:US
Practice Address - Phone:512-953-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist