Provider Demographics
NPI:1871784447
Name:JMR INC
Entity type:Organization
Organization Name:JMR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-336-2225
Mailing Address - Street 1:2031 E HOSPITALITY LN STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6603
Mailing Address - Country:US
Mailing Address - Phone:208-336-2225
Mailing Address - Fax:208-336-7757
Practice Address - Street 1:2031 E HOSPITALITY LN STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6603
Practice Address - Country:US
Practice Address - Phone:208-336-2225
Practice Address - Fax:208-336-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDV00865Medicare UPIN
ID1377190Medicare PIN