Provider Demographics
NPI:1528152261
Name:RICCI, JACK PAUL (DC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:PAUL
Last Name:RICCI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10644 MURCHIE MINE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8310
Mailing Address - Country:US
Mailing Address - Phone:415-320-0315
Mailing Address - Fax:
Practice Address - Street 1:204 PROVIDENCE MINE RD
Practice Address - Street 2:#111
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2954
Practice Address - Country:US
Practice Address - Phone:415-320-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528152261OtherNPI