Provider Demographics
NPI:1083675052
Name:RICKETTS, ROBERT KARL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KARL
Last Name:RICKETTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 UNIVERSITY AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001
Mailing Address - Country:US
Mailing Address - Phone:563-588-0500
Mailing Address - Fax:563-583-0444
Practice Address - Street 1:1400 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001
Practice Address - Country:US
Practice Address - Phone:563-588-0500
Practice Address - Fax:563-583-0444
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48982OtherBCBS
IAP00069885OtherRAILROAD MEDICARE
IA0261552Medicaid
IA0261552Medicaid
IA48982OtherBCBS