Provider Demographics
NPI:1922297852
Name:WICK, KRYSTI K (DC)
Entity Type:Individual
Prefix:DR
First Name:KRYSTI
Middle Name:K
Last Name:WICK
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 1:705 VILLAGE GREEN WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-2527
Mailing Address - Country:US
Mailing Address - Phone:262-334-4070
Mailing Address - Fax:262-334-4078
Practice Address - Street 1:705 VILLAGE GREEN WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-2527
Practice Address - Country:US
Practice Address - Phone:262-334-4070
Practice Address - Fax:262-334-4078
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4353-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor