Provider Demographics
NPI:1861622292
Name:WICKWIRE, LEE ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ADAM
Last Name:WICKWIRE
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 1:250 CIMARRON DR
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1476
Mailing Address - Country:US
Mailing Address - Phone:319-210-4430
Mailing Address - Fax:
Practice Address - Street 1:1690 BLAIRS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233
Practice Address - Country:US
Practice Address - Phone:319-393-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor