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General NPI Number Information
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NPI Number | 1558728592
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Entity Type | Organization
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Legal Business Name | SPINAL DRS INC.
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 3715 E OVERLAND RD UNIT 105
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 208-888-0055
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Fax | 208-888-5062
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Provider Business Mailing Address
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Address Line | 3715 E OVERLAND RD UNIT 105
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City | MERIDIAN
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State | ID
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Zip | 83642-8301
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Country | US
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Telephone | 208-888-0055
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Fax | 208-888-5062
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMIE MATTHEW RICKS
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Credential | D.C.
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Telephone | 208-841-3564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | CHIA 968
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License Number State | ID
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