Provider Demographics
NPI:1720326358
Name:WICKS, AMY (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
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 1:918 HEMSATH RD
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5949
Mailing Address - Country:US
Mailing Address - Phone:636-724-5757
Mailing Address - Fax:
Practice Address - Street 1:918 HEMSATH RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5949
Practice Address - Country:US
Practice Address - Phone:636-724-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201300345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor