Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2016002493 | MO |
N | 111NN1001X | Nutrition | 2016002493 | MO |
NPI | 1396190146 |
---|---|
Provider Name | Dr. Renata Rudi Rickels |
First Address | Perryville, MO 63775-2303 |
Second Address | Perryville, MO 63775-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 06/05/2016 |