Provider Demographics
NPI:1528512100
Name:RICKS, CHEDRICK
Entity type:Individual
Prefix:
First Name:CHEDRICK
Middle Name:
Last Name:RICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7213
Mailing Address - Country:US
Mailing Address - Phone:972-481-0826
Mailing Address - Fax:
Practice Address - Street 1:2121 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7213
Practice Address - Country:US
Practice Address - Phone:972-481-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization