Provider Demographics
NPI:1447780861
Name:RIDGWAY, JAIME (LAC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 GREENVILLE AVE UNIT 203
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1067
Mailing Address - Country:US
Mailing Address - Phone:828-242-2489
Mailing Address - Fax:
Practice Address - Street 1:138 CHARLOTTE ST UNIT 212
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1981
Practice Address - Country:US
Practice Address - Phone:828-242-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3830171100000X
NCLAC1030171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist