Provider Demographics
NPI:1629295498
Name:TICKEL, WILLIAM DAVID (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:TICKEL
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 1:1137 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6144
Mailing Address - Country:US
Mailing Address - Phone:701-429-3678
Mailing Address - Fax:877-818-9672
Practice Address - Street 1:819 30TH AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5000
Practice Address - Country:US
Practice Address - Phone:701-429-3678
Practice Address - Fax:877-818-9672
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor