Individual
DR. CHARLES ALLEN WICKWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
144 FAIRWAY DR, SUITE D, KERRVILLE, TX 78028-6455
(830) 792-4663
(830) 896-8161
Mailing address
144 FAIRWAY DR, SUITE D, KERRVILLE, TX 78028-6455
(830) 792-4663
(830) 896-8161
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1094575-02
—
TX
01
—
350028968
MEDICARE RR
TX
01
—
84201-BCBS
BLUE CROSS
TX
Enumeration date
10/24/2006
Last updated
01/11/2017
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