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Individual

DR. RYAN FREDERICK THEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC, MSN, APRN, FNP-C

Contact information

Practice address
13861 MANCHESTER RD, MANCHESTER, MO 63011-4503
(636) 220-9333
Mailing address
13861 MANCHESTER RD, MANCHESTER, MO 63011-4503
(618) 444-8099

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
08002660A
IN
363LF0000X
Family Nurse Practitioner
Primary
2020028106
MO
363LF0000X
Family Nurse Practitioner
209021715
IL

Other

Enumeration date
07/16/2012
Last updated
10/28/2020
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