1306632310 NPI number — RYAN EDWARD SYLVESTER MS, LAC, NCC

Table of content: RYAN EDWARD SYLVESTER MS, LAC, NCC (NPI 1306632310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306632310 NPI number — RYAN EDWARD SYLVESTER MS, LAC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYLVESTER
Provider First Name:
RYAN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAC, NCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306632310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 BOSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE GROVE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72753-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19778 BOYS HOME RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORROW
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72749-9712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-289-6818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  A2309011 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com