MEDICARE: DR. RICKY JOSEPH COLMER PHD, LAC.

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	171100000X	Acupuncturist	198-000537	IL
2	171100000X	Acupuncturist	362-055	WI

General Provider Information

NPI Number	:	1427250414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICKY JOSEPH COLMER PHD, LAC.

Provider Business Mailing Address
First Line	:	34930 N US HIGHWAY 45
Second Line	:	#108
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-691-4935
Fax Number	:

Provider Business Practice Location Address
First Line	:	34930 N US HIGHWAY 45
Second Line	:	#108
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-691-4935
Fax Number	:

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

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	04/03/2014

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