Provider Demographics
NPI:1649340159
Name:WICK CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:WICK CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WICK
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:602-843-5888
Mailing Address - Street 1:14045 N 7TH ST
Mailing Address - Street 2:#5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4388
Mailing Address - Country:US
Mailing Address - Phone:602-843-5888
Mailing Address - Fax:602-843-8836
Practice Address - Street 1:14045 N 7TH ST
Practice Address - Street 2:#5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4388
Practice Address - Country:US
Practice Address - Phone:602-843-5888
Practice Address - Fax:602-843-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty