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General NPI Number Information
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NPI Number | 1679593461
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Entity Type | Individual
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Provider Name | JOSHUA J KICKHAVER DC
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 4250 10TH ST
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City | MENOMINEE
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State | MI
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Zip | 49858-1312
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Country | US
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Telephone | 906-863-8410
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Fax | 906-863-1242
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Provider Business Mailing Address
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Address Line | 601 S 32ND AVE
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City | WAUSAU
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State | WI
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Zip | 54401-3958
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Country | US
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Telephone | 715-848-2526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4231-012
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301009285
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License Number State | MI
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