Provider Demographics
NPI:1417206780
Name:RUIZ, ALICIA A (DC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:RUIZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5216
Mailing Address - Country:US
Mailing Address - Phone:712-281-0323
Mailing Address - Fax:
Practice Address - Street 1:1122 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5216
Practice Address - Country:US
Practice Address - Phone:307-369-4700
Practice Address - Fax:307-369-4699
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor