Provider Demographics
NPI:1134443781
Name:RUHBERG, JODY (LAC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:RUHBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:RUHBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-0600
Mailing Address - Country:US
Mailing Address - Phone:206-293-2774
Mailing Address - Fax:
Practice Address - Street 1:7808 PACIFIC AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7039
Practice Address - Country:US
Practice Address - Phone:206-293-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60116655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist