NPI 1003341918

Jonathan Wicks, ATCLATMED

Practitioner Sports Medicine (Psychiatry & Neurology) Physician Bloomington, IN

Practice location

Address: 1001 E 17th St, Bloomington, IN 47408-1590
Phone: (812) 855-7920
Mailing address: 2728 S Adams St Unit 5, Bloomington, IN 47403-3296

Registered specialties

Sports Medicine (Psychiatry & Neurology) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2084S0010X Licence 36002506A (IN)

Other Psychiatry & Neurology providers in Indiana →

Registry record

NPI: 1003341918
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Apr 2017
Record last updated: 28 Apr 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.