Individual
JONATHAN WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, M.ED
Contact information
Practice address
1001 E 17TH ST, BLOOMINGTON, IN 47408-1590
(812) 855-7920
Mailing address
2728 S ADAMS ST, UNIT 5, BLOOMINGTON, IN 47403-3296
(574) 250-9007
Taxonomy
Speciality
Code
Description
License number
State
2084S0010X
Sports Medicine (Psychiatry & Neurology) Physician
Primary
36002506A
IN
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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