JONATHAN WICKS (NPI# 1003341918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084S0010X |
Psychiatry & Neurology Specialization: Sports Medicine |
36002506A | IN | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952935116 | Jonathan Maurice Wicks | Social Worker | 943 N Grand Ave, Covina, CA 91724-2046 | 2020-02-26 |
Street Address |
1001 E 17TH ST |
City | BLOOMINGTON |
State | IN |
Zip Code | 47408-1590 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 47408 |
Taxonomy Code | 2084S0010X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Sports Medicine |
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. |
City | BLOOMINGTON |
Zip Code | 47408 |
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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.