Provider Demographics
NPI:1457538621
Name:RICKER, JENNIFER L (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:RICKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19503 56TH AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5225
Mailing Address - Country:US
Mailing Address - Phone:425-776-8303
Mailing Address - Fax:425-776-8363
Practice Address - Street 1:19503 56TH AVE W
Practice Address - Street 2:STE. A
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5225
Practice Address - Country:US
Practice Address - Phone:425-776-8303
Practice Address - Fax:425-776-8363
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor