Provider Demographics
NPI:1316839178
Name:RUIZ, JOSE ALFREDO (DC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALFREDO
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S OAK GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9009
Mailing Address - Country:US
Mailing Address - Phone:805-459-1914
Mailing Address - Fax:
Practice Address - Street 1:604 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3224
Practice Address - Country:US
Practice Address - Phone:805-473-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor