Organization
CHARLES A. WICKWARE ET AL PTR
Active
Other names
Home Chiropractic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ALLEN WICKWARE D.C. (OWNER)
(830) 792-4663
Entity
Organization
Contact information
Practice address
144 FAIRWAY DR, SUITE D, KERRVILLE, TX 78028-6455
(830) 792-4663
Mailing address
144 FAIRWAY DR, SUITE D, KERRVILLE, TX 78028-6455
(830) 792-4663
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS7172
MEDICARE RR
—
Enumeration date
05/08/2007
Last updated
02/22/2012
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