Provider Demographics
NPI:1497972152
Name:RICE, JAN S (LAC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:S
Last Name:RICE
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:CAZADERO
Mailing Address - State:CA
Mailing Address - Zip Code:95421-0454
Mailing Address - Country:US
Mailing Address - Phone:707-829-1092
Mailing Address - Fax:
Practice Address - Street 1:2448 GUERNEVILLE RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-4175
Practice Address - Country:US
Practice Address - Phone:707-829-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2795171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist