Provider Demographics
NPI:1730262361
Name:WICKERT, BRIAN E (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:WICKERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3913
Mailing Address - Country:US
Mailing Address - Phone:559-584-7991
Mailing Address - Fax:559-584-2551
Practice Address - Street 1:612 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3913
Practice Address - Country:US
Practice Address - Phone:559-584-7991
Practice Address - Fax:559-584-2551
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor