Provider Demographics
NPI:1760198634
Name:RICKS, REIKER G
Entity Type:Individual
Prefix:
First Name:REIKER
Middle Name:G
Last Name:RICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12746 S MEADOW RUN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4759
Mailing Address - Country:US
Mailing Address - Phone:208-390-7472
Mailing Address - Fax:
Practice Address - Street 1:12746 S MEADOW RUN CT
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4759
Practice Address - Country:US
Practice Address - Phone:208-390-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program