Provider Demographics
NPI:1770744294
Name:WICK, KURT (LAC)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:WICK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 S MAIN ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5363
Mailing Address - Country:US
Mailing Address - Phone:941-993-5057
Mailing Address - Fax:
Practice Address - Street 1:6155 S MAIN ST
Practice Address - Street 2:SUITE 245
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5363
Practice Address - Country:US
Practice Address - Phone:941-993-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist