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General NPI Number Information
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NPI Number | 1073726956
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Entity Type | Organization
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Legal Business Name | CHARLES A. WICKWARE ET AL PTR
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 144 FAIRWAY DR SUITE D
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City | KERRVILLE
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State | TX
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Zip | 78028-6455
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Country | US
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Telephone | 830-792-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 144 FAIRWAY DR SUITE D
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City | KERRVILLE
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State | TX
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Zip | 78028-6455
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Country | US
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Telephone | 830-792-4663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES ALLEN WICKWARE
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Credential | D.C.
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Telephone | 830-792-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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