Provider Demographics
NPI:1023388907
Name:WICKHAM, DEBORAH CLARA (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:CLARA
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-9088
Mailing Address - Country:US
Mailing Address - Phone:502-732-9553
Mailing Address - Fax:
Practice Address - Street 1:301 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1421
Practice Address - Country:US
Practice Address - Phone:502-758-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor