Provider Demographics
NPI:1912446568
Name:RUIZ, RYAN ABRAHAM (LAC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ABRAHAM
Last Name:RUIZ
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 1:3135 N SEMINARY AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3308
Mailing Address - Country:US
Mailing Address - Phone:602-459-3273
Mailing Address - Fax:
Practice Address - Street 1:3135 N SEMINARY AVE
Practice Address - Street 2:UNIT G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3308
Practice Address - Country:US
Practice Address - Phone:602-459-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001351171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist