Provider Demographics
NPI:1215578547
Name:SHICK, JAMIE AUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:AUSTIN
Last Name:SHICK
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 1:7117 CRIMSON RIDGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6213
Mailing Address - Country:US
Mailing Address - Phone:779-210-2001
Mailing Address - Fax:779-210-2005
Practice Address - Street 1:7117 CRIMSON RIDGE DR STE 1
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6213
Practice Address - Country:US
Practice Address - Phone:779-210-2001
Practice Address - Fax:779-210-2005
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor