Provider Demographics
NPI:1962469411
Name:GICK, HEATHER MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:GICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:TOMASEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9011 MULDOON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46819-9710
Mailing Address - Country:US
Mailing Address - Phone:260-747-6790
Mailing Address - Fax:260-672-0005
Practice Address - Street 1:577 GEIGER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IN
Practice Address - Zip Code:46783-8877
Practice Address - Country:US
Practice Address - Phone:260-672-0004
Practice Address - Fax:260-672-0005
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002225A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor