Ryan Pedersen, L.AC., D.O.M.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

ACU-119 Issued in ID

Practice address

8783 West Hackamore Drive
Suite #8
Boise, ID 83709

Phone

(208) 376-7172

Fax

(208) 376-4778

NPI assigned

Jun 19, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1437354453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8783 WEST HACKAMORE DRIVE",
            "address_2": "SUITE #8",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83709",
            "telephone_number": "208-376-7172",
            "fax_number": "208-376-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8783 WEST HACKAMORE DRIVE",
            "address_2": "SUITE #8",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83709",
            "telephone_number": "208-376-7172",
            "fax_number": "208-376-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "RYAN",
        "credential": "L.AC., D.O.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "ID",
            "license": "ACU-119",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "ID",
            "license": "NM 831",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dallas D Peck, M.D.
• Matthew Anthony Peck, LPC
• Robert T Peck, DMD
• Theresa Michele Pecsek, PMHNP-BC
• Rachael L Pedersen, NP
• Elisabeth Pederson, LPC
• Pediatric Cardiology of Idaho
• Pediatric Dentistry Associates
• Pediatric Neurosurgry of Idaho PC
• Pediatric Surgery of Idaho

• Acupuncturist in Boise, ID
• Providers in Boise, ID by specialty
• Acupuncturist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.