MEDICARE: DR. JOSHUA R RICKERT D.C.

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	5230	MN

General Provider Information

NPI Number	:	1932333176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA R RICKERT D.C.

Provider Business Mailing Address
First Line	:	16197 MAIN AVE SE
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-1704
Country	:	US
Telephone Number	:	952-226-5100
Fax Number	:	952-516-5240

Provider Business Practice Location Address
First Line	:	16197 MAIN AVE SE
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-1704
Country	:	US
Telephone Number	:	952-226-5100
Fax Number	:	952-516-5240

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

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	11/26/2012

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