Individual
GRANT GENTRY HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
216 RIDGEWOOD DR, VIROQUA, WI 54665-8617
(608) 304-8047
Mailing address
216 RIDGEWOOD DR, VIROQUA, WI 54665-8617
(608) 304-8047
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
2035-55
WI
Other
Enumeration date
02/24/2025
Last updated
03/05/2025
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