IndividualActive
Jonathan Wicks, ATC, LAT, M.ED
NPI 1003341918 · Sports Medicine (Psychiatry & Neurology) Physician · Bloomington, IN
Provider details
- NPI number
- 1003341918
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Psychiatry & Neurology) PhysicianAllopathic & Osteopathic Physicians
- Credential
- ATC, LAT, M.ED
- Sex
- Male
- Sole proprietor
- Yes
- License
- 36002506A (IN)
Mailing address
2728 S Adams St
Bloomington, IN 47403-3296
Registry dates
- Enumerated
- 2017-04-28
- Last updated
- 2017-04-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.