Provider Demographics
NPI:1346548815
Name:RUECKL, JOSEPH VICTOR (LAC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VICTOR
Last Name:RUECKL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 NW MARKET ST
Mailing Address - Street 2:2026 MARKET ST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4080
Mailing Address - Country:US
Mailing Address - Phone:775-813-7806
Mailing Address - Fax:
Practice Address - Street 1:4319 SW OREGON ST APT 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4144
Practice Address - Country:US
Practice Address - Phone:775-813-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60204046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist