Provider Demographics
NPI:1518567668
Name:WICKERT, ZACHARY ARNOLD (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ARNOLD
Last Name:WICKERT
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:N144W6220 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2723
Mailing Address - Country:US
Mailing Address - Phone:262-377-3240
Mailing Address - Fax:
Practice Address - Street 1:N144W6220 PIONEER RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2723
Practice Address - Country:US
Practice Address - Phone:262-377-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5551-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor