MEDICARE: DR. STANLEY GEORGE 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	1108	OR

General Provider Information

NPI Number	:	1245327261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY GEORGE RICKS DC

Provider Business Mailing Address
First Line	:	1051-C NE 6TH STREET
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526
Country	:	US
Telephone Number	:	541-479-8287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051-C NE 6TH STREET
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526
Country	:	US
Telephone Number	:	541-479-8287
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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