Provider Demographics
NPI:1124326590
Name:GIRARD, RYAN JAMES (LAC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAMES
Last Name:GIRARD
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:PORT ORFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97465-0429
Mailing Address - Country:US
Mailing Address - Phone:541-373-0272
Mailing Address - Fax:
Practice Address - Street 1:29692 ELLENSBURG AVE
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-8701
Practice Address - Country:US
Practice Address - Phone:541-247-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152617171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist