Provider Demographics
NPI:1073050241
Name:RYDER JOHANSON, L.AC.
Entity Type:Organization
Organization Name:RYDER JOHANSON, L.AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RYDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KARDOKAS-JOHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-500-7233
Mailing Address - Street 1:252 9TH ST ALY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2095
Mailing Address - Country:US
Mailing Address - Phone:541-500-7233
Mailing Address - Fax:
Practice Address - Street 1:233 4TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2043
Practice Address - Country:US
Practice Address - Phone:541-500-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC180365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty