Provider Demographics
NPI:1235329533
Name:RICKETTS CLINIC OF CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:RICKETTS CLINIC OF CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-588-0500
Mailing Address - Street 1:1400 UNIVERSITY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-5917
Mailing Address - Country:US
Mailing Address - Phone:563-588-0500
Mailing Address - Fax:
Practice Address - Street 1:1400 UNIVERSITY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-5917
Practice Address - Country:US
Practice Address - Phone:563-588-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0261552Medicaid
I6518OtherMEDICARE GROUP NUMBER
I6517Medicare PIN
IAU90457Medicare UPIN