Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JONATHAN WICKS, ATC, LAT, M.ED
Active Sole ProprietorJONATHAN WICKS, ATC, LAT, M.ED is a Sports Medicine (Psychiatry) healthcare provider located in BLOOMINGTON, Indiana. NPI 1003341918 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine (Psychiatry) · BLOOMINGTON, IN
Registration Details
- NPI Number
- 1003341918
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 28, 2017 (9.1156128414066 yrs)
- Last Updated
- Apr 28, 2017
- License
-
36002506A (IN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1001 E 17TH STBLOOMINGTON, IN, 474081590Browse IN providers · Browse ZIP 47408
- Phone
- 8128557920
- Primary Specialty
-
Sports Medicine (Psychiatry)
2084S0010X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.