Healthcare Provider Details

I. General information

NPI: 1871784447
Provider Name (Legal Business Name): JMR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 E HOSPITALITY LN STE 150
BOISE ID
83716-6603
US

IV. Provider business mailing address

2031 E HOSPITALITY LN STE 150
BOISE ID
83716-6603
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-2225
  • Fax: 208-336-7757
Mailing address:
  • Phone: 208-336-2225
  • Fax: 208-336-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA968
License Number StateID

VIII. Authorized Official

Name: DR. JAMIE M RICKS
Title or Position: OWNER / DOCTOR
Credential: DC
Phone: 208-336-2225