Healthcare Provider Details

I. General information

NPI: 1023867363
Provider Name (Legal Business Name): RYDER JOHANSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 4TH ST
ASHLAND OR
97520-2043
US

IV. Provider business mailing address

252 9TH ST ALY
ASHLAND OR
97520-2095
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-7233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: RYDER KARDOKAS-JOHANSON
Title or Position: OWNER
Credential:
Phone: 541-500-7233