JONATHAN WICKS


Address: 1001 E 17th St, Bloomington, IN 47408-1590
Phone: 8128557920

JONATHAN WICKS (NPI# 1003341918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1003341918
Entity Type Individual
Full Name JONATHAN WICKS
Credential ATC, LAT, M.ED
Practice Address 1001 E 17th St
Bloomington
IN 47408-1590
Mailing Address 2728 S Adams St
Unit 5
Bloomington
IN 47403-3296
Practice Telephone 8128557920
Mailing Telephone 5742509007
Enumeration Date 2017-04-28
Last Update Date 2017-04-28
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2084S0010X Psychiatry & Neurology
Specialization: Sports Medicine
36002506A IN Allopathic & Osteopathic Physicians

Other Providers JONATHAN WICKS

NPI Name Taxonomy Address Enumeration
1952935116 Jonathan Maurice Wicks Social Worker 943 N Grand Ave, Covina, CA 91724-2046 2020-02-26

Office Location

Street Address 1001 E 17TH ST
City BLOOMINGTON
State IN
Zip Code 47408-1590

Providers in the same location

NPI Name Taxonomy Address Enumeration
1659376424 Andy S. Hipskind Family Medicine 1001 E 17th St, Bloomington, IN 47408-1590 2005-06-16
1831757541 Hannah Nicole Miller Specialist/Technologist 1001 E 17th St, Bloomington, IN 47408-1590 2019-05-29
1528525920 Jacob Steven Laverman Physical Therapist 1001 E 17th St, Bloomington, IN 47408-1590 2019-02-22
1730671934 Lewis Meyer Young Neuromusculoskeletal Medicine, Sports Medicine 1001 E 17th St, Bloomington, IN 47408-1590 2018-06-04
1811404171 Jacob Riley Proffer Specialist/Technologist 1001 E 17th St, Bloomington, IN 47408-1590 2018-01-08
1376057083 Katherine Adair O'donnell Specialist/Technologist 1001 E 17th St, Bloomington, IN 47408-1590 2017-11-17
1396277240 Athletico, Ltd. Physical Therapist 1001 E 17th St, Bloomington, IN 47408-1590 2017-03-30
1003354242 Mitch Taffe Specialist/Technologist 1001 E 17th St, Athletic Training, Bloomington, IN 47408-1590 2017-02-08
1992170898 John Pauer Specialist/Technologist 1001 E 17th St, Bloomington, IN 47408-1590 2015-12-03
1790158954 Kelly Whitney-babcock Specialist/Technologist 1001 E 17th St, Bloomington, IN 47408-1590 2015-11-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1669079398 Ta-kisha Jones Health Educator 309 N. Woodlawn Ave, Bloomington, IN 47408 2020-10-06
1265915904 Meghan Elizabeth Kinkead Specialist/Technologist Simon Skjodt Assembly Hall, 1001 East 17th Street, Bloomington, IN 47408 2018-09-10
1316499395 Marabai Rose Counseling, LLC Social Worker 4568 East State Rd 45, Bloomington, IN 47408 2016-10-26
1295133908 Eden Embree Specialist/Technologist 1001 E. 17th Street, Assembly Hall, Bloomington, IN 47408 2014-12-11
1588995229 Create-a-smile PC Dentist 219 E. 17th St., Bloomington, IN 47408 2010-01-20
1609053289 Laurette Frazier Counselor 2815 E. 10th Street, Stone Belt, Bloomington, IN 47408 2008-01-26
1770709917 Robin A. Roberts Dentist 104 E. 19th Street, Bloomington, IN 47408 2007-04-17
1376614008 David Rudolf Fletcher General Practice 126 S. Hampton Ct, Bloomington, IN 47408 2006-11-13
1114013752 Christole, Inc Intermediate Care Facility, Mentally Retarded 2727 N Dunn, Bloomington, IN 47408 2006-10-04
1003850322 Priti V Jindal Internal Medicine 2455 N Tamarack Trl, Bloomington, IN 47408 2006-06-16
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Taxonomy Information

Taxonomy Code 2084S0010X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Sports Medicine

Taxonomy Definition

A psychiatrist or neurologist who specializes in the diagnosis and treatment of sports related conditions and injuries.
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Neurology and Psychiatry.

Competitor

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City BLOOMINGTON
Zip Code 47408

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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