Provider Demographics
NPI:1316006224
Name:RICHARD JIMINES INC
Entity Type:Organization
Organization Name:RICHARD JIMINES INC
Other - Org Name:RICHARD JIMINES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-415-8068
Mailing Address - Street 1:15111 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:586-415-8068
Mailing Address - Fax:586-415-8145
Practice Address - Street 1:15111 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-415-8068
Practice Address - Fax:586-415-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301400093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33169Medicare UPIN
MI0E05141Medicare ID - Type Unspecified