Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | 001690 | KY |
N | 225XE1200X | Ergonomics | 001690 | KY |
N | 2251E1200X | Ergonomics | 05009555A | IN |
N | 225XE1200X | Ergonomics | 05009555A | IN |
Y | 2251E1200X | Ergonomics | 3582 | OH |
Y | 225XE1200X | Ergonomics | 3582 | OH |
NPI | 1922387745 |
---|---|
Provider Name | Dr. Richard Joseph Wickstrom |
First Address | West Chester, OH 45069-2497 |
Second Address | West Chester, OH 45069-2497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2011 |
Last Update Date | 10/08/2011 |