Provider Demographics
NPI:1720499858
Name:WICK, ANDREA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
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:PO BOX 161131
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-1131
Mailing Address - Country:US
Mailing Address - Phone:262-893-8316
Mailing Address - Fax:
Practice Address - Street 1:169 SNOWY MOUNTAIN CIRCLE
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716-1131
Practice Address - Country:US
Practice Address - Phone:262-893-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2376111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition