Provider Demographics
NPI:1215193388
Name:RICKER, PHILIP R (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:RICKER
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ELK MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2106
Mailing Address - Country:US
Mailing Address - Phone:828-232-1002
Mailing Address - Fax:
Practice Address - Street 1:12 ELK MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2106
Practice Address - Country:US
Practice Address - Phone:828-232-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist