Provider Demographics
NPI:1780738369
Name:BRICKER, KENNETH MARSHALL (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARSHALL
Last Name:BRICKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HUTT HOSPITAL, VALLEY IMAGING AND X-RAY
Mailing Address - Street 2:PRIVATE BAG 31907
Mailing Address - City:LOWER HUTT
Mailing Address - State:WELLINGTON
Mailing Address - Zip Code:5040
Mailing Address - Country:NZ
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HUTT HOSPITAL
Practice Address - Street 2:HIGH STREET
Practice Address - City:LOWER HUTT
Practice Address - State:WELLINGTON
Practice Address - Zip Code:5040
Practice Address - Country:NZ
Practice Address - Phone:644-570-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56493-212085R0202X
MN17812390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology