MEDICARE: RYDER JOHANSON, L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC180365	OR

General Provider Information

NPI Number	:	1073050241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYDER JOHANSON, L.AC.

Provider Business Mailing Address
First Line	:	337 TAYLOR ST
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-3057
Country	:	US
Telephone Number	:	541-500-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 4TH ST
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2043
Country	:	US
Telephone Number	:	541-500-7233
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	RYDER KARDOKAS-JOHANSON
Credential	:	L.AC.
Telephone Number	:	541-500-7233

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/12/2026

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