Robert  K  Ricketts    DC
Contract Details
Facility name
Provider ID
P000004086
NPI
1235329533
Tax ID
731643152
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1400 University Ave Suite B
Dubuque, IA 52001
United States
County
Dubuque
Phone
5635880500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address