Provider Demographics
NPI:1952520157
Name:VICKERS, JOEL BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BRIAN
Last Name:VICKERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S WAVERLY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3016
Mailing Address - Country:US
Mailing Address - Phone:616-738-1200
Mailing Address - Fax:616-738-1229
Practice Address - Street 1:1 S WAVERLY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3016
Practice Address - Country:US
Practice Address - Phone:616-738-1200
Practice Address - Fax:616-738-1229
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor