Healthcare Provider Details

I. General information

NPI: 1679593461
Provider Name (Legal Business Name): JOSHUA J KICKHAVER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 10TH ST
MENOMINEE MI
49858-1312
US

IV. Provider business mailing address

601 S 32ND AVE
WAUSAU WI
54401-3958
US

V. Phone/Fax

Practice location:
  • Phone: 906-863-8410
  • Fax: 906-863-1242
Mailing address:
  • Phone: 715-848-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4231-012
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: