Provider Demographics
NPI:1558699314
Name:AMES, RICKIE LANE (D,C,)
Entity Type:Individual
Prefix:DR
First Name:RICKIE
Middle Name:LANE
Last Name:AMES
Suffix:
Gender:M
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LONGVIEW DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3628
Mailing Address - Country:US
Mailing Address - Phone:207-907-2637
Mailing Address - Fax:207-990-2308
Practice Address - Street 1:804 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3614
Practice Address - Country:US
Practice Address - Phone:207-907-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1730510090OtherCLINIC NPI