MEDICARE: DR. LISA RUIZ D.C.

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	111N00000X	Chiropractor	CH00003507	WA

General Provider Information

NPI Number	:	1356494843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA RUIZ D.C.

Provider Business Mailing Address
First Line	:	509 OLIVE WAY
Second Line	:	SUITE 1342
City	:	SEATTLE
State	:	WA
Zip	:	98101-1720
Country	:	US
Telephone Number	:	206-682-5885
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY
Second Line	:	SUITE 1342
City	:	SEATTLE
State	:	WA
Zip	:	98101-1720
Country	:	US
Telephone Number	:	206-682-5885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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