Provider Demographics
NPI:1013081538
Name:WICKS, VERONICA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ANN
Last Name:WICKS
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 1:70 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-2941
Mailing Address - Country:US
Mailing Address - Phone:151-679-6480
Mailing Address - Fax:151-679-3696
Practice Address - Street 1:70 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-2941
Practice Address - Country:US
Practice Address - Phone:151-679-6480
Practice Address - Fax:151-679-3696
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005804-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOO5804-2OtherD.C. LICENSE