Individual
RYAN PEDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.AC., D.O.M.
Contact information
Practice address
8783 WEST HACKAMORE DRIVE, SUITE #8, BOISE, ID 83709
(208) 376-7172
(208) 376-4778
Mailing address
8783 WEST HACKAMORE DRIVE, SUITE #8, BOISE, ID 83709
(208) 376-7172
(208) 376-4778
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
ACU-119
ID
171100000X
Acupuncturist
NM 831
ID
Other
Enumeration date
06/19/2007
Last updated
07/09/2007
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