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Individual

KURTIS CARL WICKLUND

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
623 MADISON ST, BRAINERD, MN 56401-4518
(218) 829-5380
(218) 825-0972
Mailing address
623 MADISON ST, BRAINERD, MN 56401-4518
(218) 829-5380
(218) 825-0972

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2815
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5C982WI
BLUE CROSS BLUE SHIELD
MN
Enumeration date
05/31/2006
Last updated
07/08/2007
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