Provider Demographics
NPI:1427250414
Name:COLMER, RICKY JOSEPH (PHD, LAC)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:JOSEPH
Last Name:COLMER
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34930 N US HIGHWAY 45
Mailing Address - Street 2:#108
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7537
Mailing Address - Country:US
Mailing Address - Phone:847-691-4935
Mailing Address - Fax:
Practice Address - Street 1:34930 N US HIGHWAY 45
Practice Address - Street 2:#108
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-7537
Practice Address - Country:US
Practice Address - Phone:847-691-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000537171100000X
WI362-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist