Individual
BRIAN S ICKE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1066 4TH ST, SUITE B, SANTA ROSA, CA 95404-4321
(707) 545-1650
Mailing address
1066 4TH ST, SUITE B, SANTA ROSA, CA 95404-4321
(707) 545-1650
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
22374
CA
Other
Enumeration date
08/26/2005
Last updated
07/08/2007
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