Provider Demographics
NPI:1659443141
Name:JOY, RICKIE EDD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKIE
Middle Name:EDD
Last Name:JOY
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 1:1012 CARVER ROAD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-549-2215
Mailing Address - Fax:209-549-2216
Practice Address - Street 1:1012 CARVER ROAD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-549-2215
Practice Address - Fax:209-549-2216
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGDC000520Medicaid
21383OtherCA LICENSE NUMBER
435617Medicare UPIN
21383OtherCA LICENSE NUMBER