Organization
TL-JST, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS ALAN WICKS PH.D., D.C. (DIRECTOR)
(563) 359-1702
Entity
Organization
Contact information
Practice address
1750 PRAIRIE VISTA CIR, BETTENDORF, IA 52722-1828
(563) 359-1702
Mailing address
1750 PRAIRIE VISTA CIR, BETTENDORF, IA 52722-1828
(563) 359-1702
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
A5695
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11784
BLUE CROSS / BLUE SHIELD
IA
Enumeration date
03/27/2006
Last updated
08/22/2020
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