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General NPI Number Information
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NPI Number | 1316006224
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Entity Type | Organization
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Legal Business Name | RICHARD JIMINES INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15111 13 MILE RD
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City | WARREN
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State | MI
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Zip | 48088
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Country | US
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Telephone | 586-415-8068
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Fax | 586-415-8145
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Provider Business Mailing Address
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Address Line | 15111 13 MILE RD
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City | WARREN
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State | MI
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Zip | 48088
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Country | US
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Telephone | 586-415-8068
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Fax | 586-415-8145
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | DR. RICHARD JIMINES
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Credential | DC
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Telephone | 586-415-8068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301400093
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License Number State | MI
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