MEDICARE: DR. JAMIE M RICKS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIA968	ID

General Provider Information

NPI Number	:	1053379610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE M RICKS DC

Provider Business Mailing Address
First Line	:	2031 E HOSPITALITY LANE
Second Line	:	SUITE 150
City	:	BOISE
State	:	ID
Zip	:	83716
Country	:	US
Telephone Number	:	208-336-2225
Fax Number	:	208-336-7757

Provider Business Practice Location Address
First Line	:	2031 E HOSPITALITY LANE
Second Line	:	SUITE 150
City	:	BOISE
State	:	ID
Zip	:	83716
Country	:	US
Telephone Number	:	208-336-2225
Fax Number	:	208-336-7757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JAMIE M RICKS DC” Practice Location

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