Provider Demographics
NPI:1053379610
Name:RICKS, JAMIE M (DC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:RICKS
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 1:2031 E HOSPITALITY LANE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716
Mailing Address - Country:US
Mailing Address - Phone:208-336-2225
Mailing Address - Fax:208-336-7757
Practice Address - Street 1:2031 E HOSPITALITY LANE
Practice Address - Street 2:SUITE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716
Practice Address - Country:US
Practice Address - Phone:208-336-2225
Practice Address - Fax:208-336-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00865Medicare UPIN
ID1377190Medicare ID - Type UnspecifiedGROUP PRICING