Provider Demographics
NPI:1447221619
Name:WICKS, THOMAS JAY (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAY
Last Name:WICKS
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 1:551 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TRAER
Mailing Address - State:IA
Mailing Address - Zip Code:50675-1138
Mailing Address - Country:US
Mailing Address - Phone:319-478-8515
Mailing Address - Fax:319-478-8497
Practice Address - Street 1:551 2ND ST
Practice Address - Street 2:
Practice Address - City:TRAER
Practice Address - State:IA
Practice Address - Zip Code:50675-1138
Practice Address - Country:US
Practice Address - Phone:319-478-8515
Practice Address - Fax:319-478-8497
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1257816Medicaid
IA38385OtherWELLMARK,BCBS
IA1257816Medicaid
IAT01459Medicare UPIN